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Chokroverty L. Depression Part 2: Treatment. Pediatr Rev 2024; 45:494-504. [PMID: 39217118 DOI: 10.1542/pir.2024-006479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 09/04/2024]
Abstract
Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through collaborative care include nonpharmacologic therapies such as psychosocial treatments and evidence-based psychotherapies, and pharmacotherapy and monitoring processes for depression. Abundant support and guidance are available to pediatricians in depression care, including mental health consultation and online materials.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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2
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Chokroverty L. Depression Part 1: Evaluation. Pediatr Rev 2024; 45:483-493. [PMID: 39217122 DOI: 10.1542/pir.2022-005688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 09/04/2024]
Abstract
By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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3
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Hershberger PJ, Bricker DA, Castle A, Crawford TN, Flowers SR, Goff AL, Conway K. Compassionate Curiosity: Mitigating the Effects of Bias Through Motivational Interviewing. Health Equity 2024; 8:351-354. [PMID: 39011081 PMCID: PMC11249126 DOI: 10.1089/heq.2024.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient's point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Stacy R Flowers
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Alexandria L Goff
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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Matthews JA, Matthews S, Faries MD, Wolever RQ. Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts. Mayo Clin Proc Innov Qual Outcomes 2024; 8:263-275. [PMID: 38807973 PMCID: PMC11130595 DOI: 10.1016/j.mayocpiqo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a "coach approach" to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.
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Affiliation(s)
- Jessica A. Matthews
- College of Health Sciences, Point Loma Nazarene University, San Diego, CA
- Department of Family Medicine, Centers for Integrative Health, UC San Diego Health, San Diego, CA
| | - Simon Matthews
- Lifestyle Medicine and Health Research Centre, Avondale University, Cooranbong, Australia
- Wellcoaches School of Coaching, Wellesley, MA
| | - Mark D. Faries
- Family & Community Health, Texas A&M AgriLife Extension, College Station, TX
- Texas A&M School of Medicine and School of Public Health, College Station, TX
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt Health Coaching, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University School of Nursing, Nashville, TN
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5
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Chronis-Tuscano A, Bounoua N. ADHD Prevalence Rose, Yet Disparities Remain: Commentary on the 2022 National Survey of Children's Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:361-372. [PMID: 38905157 PMCID: PMC11193851 DOI: 10.1080/15374416.2024.2359075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
This is a commentary on Danielson and colleagues' report entitled "ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment," which provides updated prevalence rates related to ADHD diagnosis and treatment utilization using data from the 2022 National Survey of Children's Health (NSCH). This timely article is among the first to report on ADHD prevalence rates since the COVID-19 pandemic, and highlights important patterns related to ADHD diagnosis and treatment utilization. In this commentary, we contextualize these findings with consideration to the COVID-19 pandemic and within the existing literature on health disparities among youth with ADHD and their families. We end with recommendations for future work involving researchers, clinicians, and policymakers with the intention of reducing disparities in ADHD diagnosis and treatment in the U.S.
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Hershberger PJ, Flowers SR, Bayless SL, Conway K, Crawford TN. Interface Between Motivational Interviewing and Burnout. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:181-187. [PMID: 38495574 PMCID: PMC10941786 DOI: 10.2147/amep.s450179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/11/2024] [Indexed: 03/19/2024]
Abstract
Background The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians. Methods We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions. Results A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout. Conclusion Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Stacy R Flowers
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Sharlo L Bayless
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Hershberger PJ, Pei Y, Bricker DA, Crawford TN, Shivakumar A, Castle A, Conway K, Medaramitta R, Rechtin M, Wilson JF. Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI. BMC MEDICAL EDUCATION 2024; 24:237. [PMID: 38443862 PMCID: PMC10916112 DOI: 10.1186/s12909-024-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Yong Pei
- Department of Computer Science, College of Computing and Software Engineering, Kennesaw State University, Kennesaw, GA, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashutosh Shivakumar
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Raveendra Medaramitta
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Maria Rechtin
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Josephine F Wilson
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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D'Amico LN, Hanania H, Lee LT. Enhancing Provider Mental Health Screening in Primary Care: A Quality Improvement Project. J Dr Nurs Pract 2023; 16:196-204. [PMID: 38049182 DOI: 10.1891/jdnp-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Background: Depression and anxiety occur in 7.8% and 19.1% of the US population, respectively. About half of those patients are diagnosed in primary care. Objective: The purpose of this quality improvement project was to improve the screening and diagnosing of anxiety and/or depression among adult patients at a primary care clinic by implementing an evidence-based mental health screening interview technique. Methods: The team implemented a mental health screening interview technique that incorporates background, affect, trouble, handling, and empathy and motivational interviewing techniques in addition to self-report surveys. Pre- and post-intervention surveys were conducted to assess providers' perceptions of the new interview technique. ICD-10 code data were gathered to assess the effectiveness of the new mental health screening interview technique. Results: The number of documented diagnoses of single-episode major depressive disorder decreased by 18%, recurrent major depressive disorder increased by 34%, and anxiety disorders increased by 3%. There were more favorable provider perceptions of the new screening interview technique versus the traditional screening method. Conclusions: The results show an improvement in provider comfort and providers preferred the new mental health screening when using an evidence-based mental health screening interview technique. Implications for nursing: The results show the potential benefits of using a structured mental health interview with self-report screening tools when diagnosing anxiety and depression in primary care.
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Affiliation(s)
- Lauren N D'Amico
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Hannah Hanania
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Loretta T Lee
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
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Nurmi J, Knittle K, Naughton F, Sutton S, Ginchev T, Khattak F, Castellano-Tejedor C, Lusilla-Palacios P, Ravaja N, Haukkala A. Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App. JMIR Form Res 2023; 7:e34232. [PMID: 37995122 DOI: 10.2196/34232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/06/2022] [Accepted: 05/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals. OBJECTIVE This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability-based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps. METHODS In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events). RESULTS All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=-1524; P<.001) on daily steps. CONCLUSIONS The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs.
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Affiliation(s)
- Johanna Nurmi
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Keegan Knittle
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Todor Ginchev
- Department of Communications and Networking, Aalto University, Espoo, Finland
| | - Fida Khattak
- Department of Communications and Networking, Aalto University, Espoo, Finland
| | - Carmina Castellano-Tejedor
- Grupo de Investigación en Estrés y Salud, Basic Psychology Department, Autonomous University of Barcelona, Barcelona, Spain
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili & Vall d'Hebron Research Institute, Barcelona, Spain
- Psiquiatría, Salud Mental y Adicciones, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Pilar Lusilla-Palacios
- Psiquiatría, Salud Mental y Adicciones, Vall d'Hebron Institut de Recerca, Barcelona, Spain
- Servicio de Psiquiatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Niklas Ravaja
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ari Haukkala
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
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Claus LE, Barton Laws M, Wilson IB, Han D, Saha S, Moore RD, Beach MC. Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand? AIDS Behav 2023; 27:3780-3788. [PMID: 37792233 DOI: 10.1007/s10461-023-04135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 10/05/2023]
Abstract
HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic. We identified and coded episodes of behavior change counseling to determine clinicians' consistency with motivational interviewing (MI) and used multi-level regression to evaluate counseling quality changes with each additional topic. Clinician counseling for at least one behavior was indicated in 92% of visits (mean 2.5/visit). Behavioral topics included antiretroviral medication adherence (80%, n = 163), appointment adherence (54%, n = 110), drug use (46%, n = 95), tobacco use (45%, n = 93), unsafe sex (43%, n = 89), weight management (39%, n = 80), and alcohol use (35%, n = 71). Clinician counseling was most MI-consistent when discussing drug and tobacco use and least consistent for medication and appointment adherence, unsafe sex, and alcohol use. In multilevel analyses, clinician counseling was significantly less MI-consistent (β = - 0.14, 95% CI - 0.29 to - 0.001) with each additional behavior change counseling need. This suggests that HIV ambulatory care be restructured to allocate increased time for patients with greater need for behavior change.
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Affiliation(s)
- Lauren E Claus
- Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21205, USA.
| | | | - Ira B Wilson
- Brown School of Public Health, Providence, RI, USA
| | - Dingfen Han
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Somnath Saha
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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van de Ven D, Schuring M, Kouwenhoven-Pasmooij TA, Blom P, Burdorf A, Robroek SJW. Reach and effectiveness of a worksite health promotion program combining a preventive medical examination with motivational interviewing; a quasi-experimental study among workers in low socioeconomic position. BMC Public Health 2023; 23:2130. [PMID: 37904106 PMCID: PMC10617210 DOI: 10.1186/s12889-023-16908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND This study aimed to evaluate individual characteristics associated with participation and effectiveness of a worksite health promotion program with motivational interviewing targeting health and health behaviour among Dutch workers in low socioeconomic position. METHODS In a production company and a hospital, 838 workers were invited for a Preventive Medical Examination and subsequent coaching with motivational interviewing up to 7 sessions within 6 months. Follow-up information was collected after 6 months. Characteristics associated with participation in coaching were assessed with logistic regression models. The effectiveness of coaching on body mass index (BMI), bodyweight, self-rated health, vigorous physical activity, smoking, alcohol intake, fruit- and vegetable consumption, work ability, and sickness absence was evaluated with linear regression models and on participation in health promotion activities with logistic regression analysis. The analyses on effectiveness were performed without and with propensity score adjustment. RESULTS Of the 838 invited workers, 313 workers participated in the Preventive Medical Examination and follow-up data were available for 176 workers, of whom 100 workers with increased cardiovascular risk attended coaching. The majority of workers with obesity (73%), overweight (60%), and unhealthy behaviours (58%-69%) at baseline participated in motivational interviewing. Males, workers with overweight or obesity, workers at the production company, workers with insufficient vigorous physical activity, and workers with a low educational level were most likely to participate in coaching. Coaching with motivational interviewing after the Preventive Medical Examination was associated with a 4.74 times higher likelihood [95% confidence interval (CI): 1.99;11.32] to participate in health promotion activities and 10.9% (95%CI: 0.6;21.3) more persons who quit smoking compared to workers without coaching. No statistically significant effects were observed on BMI, bodyweight, health, health behaviour, work ability and sickness absence. CONCLUSIONS The program combining a Preventive Medical Examination with follow-up coaching reached - as intended - workers with obesity or overweight, those with a low education and with unhealthy behaviours. Adding coaching with motivational interviewing to a Preventive Medical Examination contributed to higher participation in health promotion activities and an increase in smoking cessation after 6 months among workers with a lower socioeconomic position, but was not effective on other outcomes. TRIAL REGISTRATION The study was registered retrospectively in the Netherlands Trial Register as NL8178 on 22/11/2019.
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Affiliation(s)
- David van de Ven
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | | | - Philip Blom
- Health Centre Zwolle, Zwolle, the Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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Dangerfield DT, Davis G, Pandian V, Anderson JN. Using Motivational Interviewing to Increase HIV PrEP Initiation and Adherence: a Scoping Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1365-1375. [PMID: 37249729 PMCID: PMC10575988 DOI: 10.1007/s11121-023-01554-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
Despite evidence that pre-exposure prophylaxis (PrEP) reduces HIV risk, initiation and adherence remain low among vulnerable communities. Motivational interviewing (MI) can improve HIV prevention behaviors. However, limited research identifies how MI impacts PrEP uptake and adherence. This scoping review examines essential components of MI-based interventions that aimed to improve PrEP use, including the number and duration of sessions, counselor characteristics, and interview content. We searched four databases, PubMed, CINAHL Plus, Embase, and Web of Science, and reviewed 379 articles. Studies were considered if they (a) were published between 2012 and 2023, (b) used MI independently or part of a multi-component intervention strategy, and (c) focused on improving PrEP initiation or adherence. Seven articles met inclusion criteria. Regarding intervention components, the number of MI sessions varied and duration ranged between 15 and 60 min. MI counselors varied in credentialing and demographic characteristics. MI content included PrEP education, identifying initiation and adherence barriers, and strategizing ways to overcome barriers. MI is an important component of interventions that aim to improve PrEP initiation and adherence. However, the variability and limited details across studies hinder our ability to assess MI efficacy on PrEP initiation and adherence or replicate these approaches in future interventions.
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Affiliation(s)
- Derek T Dangerfield
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Washington, DC, 20052, USA.
| | - Gerrin Davis
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | | | - Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
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Caiata-Zufferey M, De Pietro C. Motivational interviewing for prevention in Swiss family medicine: Opportunities and challenges. Prev Med Rep 2023; 35:102351. [PMID: 37564119 PMCID: PMC10410595 DOI: 10.1016/j.pmedr.2023.102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
Health promotion and primary prevention are a priority in a healthcare system characterised by a prevalence of chronic conditions. In this context, motivational interviewing (MI) as provided by family doctors (FDs) seems promising: influential health professionals motivate patients to adopt healthy lifestyles in a patient-centred style that promotes a balanced, horizontal doctor-patient relationship. Based on these assumptions, a pilot project called Girasole was implemented in Switzerland between 2016 and 2018 to train and support 19 FDs in implementing MI in their practices. This paper presents the analysis of implementation of the intervention with the aim of exploring the doctors' experiences with MI through a qualitative research design. Data derive from focus groups and interviews with the participants, and from the observation of collective training sessions and follow-up meetings. A thematic analysis was conducted using the software Atlas.ti. Results show that there is great diversity in how FDs implement MI. FDs can be classified in four groups - convinced, interested, critical, and resistant - based on their adherence to the principles underlying the MI approach. This taxonomy highlights opportunities and challenges for family medicine: MI offers flexible tools and new ways of interacting with patients to meet the challenges of non-communicable and chronic diseases; at the same time, the issues associated with the medicalisation of human everyday problems, physicians' status loss, and low cost-effectiveness should not be underestimated. Any further attempt to promote MI among FDs should take into account their individual attitudes and should establish tailored approaches and training methods.
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Affiliation(s)
- Maria Caiata-Zufferey
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Department of Business Economics, Health and Social Care (DEASS), Stabile Piazzetta, Via Violino 11, CH-6928 Manno, Switzerland
| | - Carlo De Pietro
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Department of Business Economics, Health and Social Care (DEASS), Stabile Piazzetta, Via Violino 11, CH-6928 Manno, Switzerland
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Edelman EJ, Rojas-Perez OF, Nich C, Corvino J, Frankforter T, Gordon D, Jordan A, Paris M, Weimer MB, Yates BT, Williams EC, Kiluk BD. Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population. Addict Sci Clin Pract 2023; 18:55. [PMID: 37726823 PMCID: PMC10510167 DOI: 10.1186/s13722-023-00407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach. METHODS We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost-benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use. CONCLUSIONS Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05338151.
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Affiliation(s)
- E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA.
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Social and Behavioral Sciences, Yale School of Medicine, New Haven, CT, USA.
| | | | - Charla Nich
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joanne Corvino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tami Frankforter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Derrick Gordon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- The Consultation Center, New Haven, CT, USA
| | - Ayana Jordan
- Department of Psychiatry, NYU Langone Health, New York, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Hispanic Clinic, Connecticut Mental Health Center, New Haven, CT, USA
| | - Melissa B Weimer
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Brian T Yates
- Department of Psychology, American University, Washington, DC, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research and Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration (VA), Seattle, WA, USA
| | - Brian D Kiluk
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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15
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Boness CL, Witkiewitz K. Precision medicine in alcohol use disorder: Mapping etiologic and maintenance mechanisms to mechanisms of behavior change to improve patient outcomes. Exp Clin Psychopharmacol 2023; 31:769-779. [PMID: 36355681 PMCID: PMC10169540 DOI: 10.1037/pha0000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Precision medicine has been advanced as a potential solution to the problem of alcohol use disorder heterogeneity and modest alcohol use disorder treatment efficacy. The success of precision medicine lies in our ability to first identify the etiologic and maintenance mechanisms at play for a given person and then choose the treatment that is most likely to address such mechanisms. There exist several frameworks that describe empirically supported substance use disorder (SUD) etiologic and maintenance mechanisms (e.g., the Etiologic, Theory-based, Ontogenetic, Hierarchical [ETOH] Framework). There also exists a large literature on mechanisms of behavior change in alcohol use disorder treatment. However, the mechanism of behavior change literature on alcohol use disorder treatments has focused broadly on mechanisms of change rather than more specifically on core alcohol use disorder etiologic and maintenance mechanisms. Thus, the two types of mechanisms have never been integrated or systematically evaluated for their overlap. As such, the aim of the present brief review is to demonstrate how commonly used alcohol use disorder treatments may overlap with and directly target certain alcohol use disorder etiologic and maintenance mechanisms (specifically those described by the ETOH framework). We delineate empirically plausible overlapping mechanisms and theoretically plausible overlapping mechanisms that warrant more research. Last, based on the identification of empirically and theoretically plausible overlapping mechanisms, we elaborate on how ongoing work related to alcohol use disorder precision medicine may test specific hypotheses regarding which treatments work best for whom. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Cassandra L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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16
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Shields GS, Fisher M, Vega MO. Teaching power skills to improve physician self-efficacy, reduce burnout, and improve patient outcomes. Future Healthc J 2023; 10:119-123. [PMID: 37786631 PMCID: PMC10540802 DOI: 10.7861/fhj.2023-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
If doctors had a way to improve their patients' healthcare experience, improve service feedback, reduce complaints, increase treatment adherence and reduce non-attendance, while at the same time combatting burnout and compassion fatigue in clinicians and enhancing collaborative working between staff and care teams, and all for zero direct cost, could anyone argue against such an intervention? In this paper, we present the views of the educators and clinicians at Maudsley Learning that training in communication and psychological 'power skills' is not only feasible, but crucially important for physicians at all stages of training to improve both patient care and the wellbeing of clinicians themselves. We explore some of the key relevant skills and present examples of high-fidelity simulation training that demonstrate the efficacy of this modality in improving individual skills and confidence as well as inter-team and interdisciplinary working.
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Affiliation(s)
- Gregory S Shields
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
| | - Megan Fisher
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
| | - Marta Ortega Vega
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
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17
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Mansoury O, Essoli S, Kachkouch H, Mansouri A, Adarmouch L, Amine M, Sebbani M. General practitioners' knowledge, attitudes and practices towards health promotion in Morocco. Niger Postgrad Med J 2023; 30:226-231. [PMID: 37675699 DOI: 10.4103/npmj.npmj_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Health promotion (HP) is a part of the general practitioners' (GPs) competencies defined by the World Organization of Family Doctors. The implementation of HP in their practice is unsatisfactory. Aims The aim of this study was to explore GPs knowledge, attitudes and practices in Morocco about HP at the primary healthcare services. Methods A cross-sectional study was conducted using an online self-administrated questionnaire including, knowledge, attitudes and practices of GPs toward HP. Descriptive and bivariate analyses were conducted. Results Two hundred and forty GPs responded to our questionnaires, the sex ratio was 1.12 with an average age of 40.46 ± 9.05 years. More than half of our participants perceived HP as a concept indistinct from prevention, 70.4% believed that HP refers to the biomedical model. On a Likert scale of 1-5, the level of HP knowledge was 2.71 ± 1.13. The most discussed topics with the population were tobacco, alcohol, overweight and obesity. Statistically significant association was found between the competencies of GPs in lifestyle behaviours and the practice of this competence. Conclusion The knowledge of GPs remains insufficient, and their practices focus more on the areas in which they feel competent, which requires the implementation of specific training for the development of GPs skills in HP.
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Affiliation(s)
- Ouassim Mansoury
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Samira Essoli
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Hamza Kachkouch
- Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakesh, Morocco
| | - Adil Mansouri
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Latifa Adarmouch
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Mohamed Amine
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Majda Sebbani
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco; Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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18
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Veinot TC, Gillespie B, Argentina M, Bragg-Gresham J, Chatoth D, Collins Damron K, Heung M, Krein S, Wingard R, Zheng K, Saran R. Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46187. [PMID: 37079365 PMCID: PMC10160944 DOI: 10.2196/46187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. OBJECTIVE This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. METHODS This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. RESULTS This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. CONCLUSIONS The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46187.
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Affiliation(s)
- Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brenda Gillespie
- Department of Biostatistics, Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Jennifer Bragg-Gresham
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Michael Heung
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
| | - Sarah Krein
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs, Ann Arbor, MI, United States
| | | | - Kai Zheng
- School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
| | - Rajiv Saran
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
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Löyttynen J, Graneheim UH, Hörnsten Å. District Nurses' Experiences of Practice in Caring for People with Mental Ill-Health in Swedish Primary Care. Issues Ment Health Nurs 2023; 44:396-405. [PMID: 37053044 DOI: 10.1080/01612840.2023.2193639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Mental ill-health is one of the greatest public health challenges in Sweden, and it is estimated that every third person seeking primary care in the country suffers from mental ill-health. Without proper treatment at an early stage, mental ill-health may lead to long-term illness and have a significant impact on functional ability. As district nurses are specialists in public health nursing, they have been pointed out as having a key role in the prevention and management of mental ill-health. The aim was to explore district nurses' practice in caring for people with mental ill-health within primary health care. Individual semi-structured interviews were conducted with district nurses (n = 18) and the transcribed text was subjected to qualitative content analysis. The result was formulated as several subthemes, eventually developed into three themes: Practicing within an organisation where traditional attitudes are impediments, Perceiving mental healthcare as not being an obvious part of district nursing, Working as fellow human beings rather than "professionals". The findings indicate that district nurses feel uncertainty in their practice in this area. Working independently with mental ill-health was not always considered socially acceptable among district nurses. Despite these challenges they tried to remain involved without becoming emotionally overwhelmed. They also strived to meet the needs of these patients with 'small things', that could be effective and a part of recovery-oriented practice, even if they might be defined as unprofessional, and their efficacy negated.
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Affiliation(s)
| | - Ulla Hällgren Graneheim
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
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20
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Harkin K, Apostolopoulos V, Tangalakis K, Irvine S, Tripodi N, Feehan J. The impact of motivational interviewing on behavioural change and health outcomes in cancer patients and survivors. A systematic review and meta-analysis. Maturitas 2023; 170:9-21. [PMID: 36736204 DOI: 10.1016/j.maturitas.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cancer patients and survivors commonly have poorer health behaviours and subsequent outcomes, often as a result of negative impacts of diagnosis and treatment. Motivational interviewing is reported to be an effective psychological tool to produce a shift in one's behaviour resulting in improved outcomes. However, there is a lack of analyses investigating this tool's impact on healthy behaviours and health outcomes in cancer populations. OBJECTIVE To investigate the effect of motivational interviewing on behaviours and health outcomes in cancer populations. METHODS The studies were identified from four databases using variations of the terms "cancer" and "motivational interviewing". Randomised trials, non-randomised trials and quasi-experimental studies which contained control (or usual care) comparators were included. Risk of bias was assessed using the Cochrane Risk of Bias Version 5.1.0 and the Risk of Bias In Non-Randomised Studies of Interventions tools. The quality of evidence was assessed using the GRADE framework. Means difference and standardised mean differences and 95 % confidence intervals were used to report the pooled effects using a random effects model. RESULTS Twenty-one studies were included in the review and 17 studies were included in the meta-analysis. A total of 1752 cancer patients and survivors received MI as an intervention (or part thereof). Quality of life, anxiety, depression, functional tasks (6-minute walk test), body mass index and body weight (BMI/BW), physical activity (PA), self-efficacy and fatigue were outcomes measured in the selected studies. Effects were seen in functional tasks, physical activity, BMI/BW, depression and self-efficacy. All of these outcomes were from studies that were classed as very low-quality evidence except for BMI/BW and PA, which were from moderate-quality evidence. CONCLUSION Motivational interviewing had positive effects on functional tasks, PA, BMI/BW, depression and self-efficacy in people diagnosed with cancer. However, more higher-quality studies need to be conducted to further ascertain the effect of this intervention.
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Affiliation(s)
- Katherine Harkin
- Institute for Health and Sport, Victoria University, Melbourne, Australia; First Year College, Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, The University of Melbourne and Western Health, St. Albans, Australia
| | - Kathy Tangalakis
- First Year College, Victoria University, Melbourne, Australia; Institute for Sustainable Industries & Liveable Cities, Victoria University, Melbourne, Australia
| | - Susan Irvine
- First Year College, Victoria University, Melbourne, Australia
| | - Nicholas Tripodi
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, The University of Melbourne and Western Health, St. Albans, Australia; First Year College, Victoria University, Melbourne, Australia.
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, The University of Melbourne and Western Health, St. Albans, Australia.
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21
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Braun A, Portner J, Xu M, Weaver L, Pratt K, Darragh A, Spees CK. Preliminary Support for the Use of Motivational Interviewing to Improve Parent/Adult Caregiver Behavior for Obesity and Cancer Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4726. [PMID: 36981636 PMCID: PMC10048747 DOI: 10.3390/ijerph20064726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Motivational interviewing (MI) is a promising behavioral intervention for improving parent and adult caregiver (PAC) health behavior for obesity and cancer prevention. This study explored the preliminary effects of MI from a registered dietitian (RDMI) within an obesity prevention intervention to promote PAC behavior change and positive proxy effects on children and the home environment. N = 36 PAC/child dyads from low-resource communities were enrolled in a randomized trial testing a 10-week obesity prevention intervention. Intervention dyads were offered RDMI sessions. Data were collected at baseline and post-intervention (PAC diet quality (Healthy Eating Index (HEI)), child skin carotenoids, home environment, and PAC ambivalence regarding improving diet). Results show that for every RDMI dose, PAC HEI scores increased (0.571 points, p = 0.530), child skin carotenoid scores improved (1.315%, p = 0.592), and the home food environment improved (3.559%, p = 0.026). There was a significant positive relationship between RDMI dose and change in ambivalence (ρ = 0.533, p = 0.007). Higher baseline ambivalence was associated with greater dose (ρ = -0.287, p = 0.173). Thus, RDMI for PACs may improve diets among PACs who are otherwise ambivalent, with potential effects on the diets of their children and the home food environment. Such intervention strategies have the potential for greater effect, strengthening behavioral interventions targeting obesity and cancer.
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Affiliation(s)
- Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University, Stillwater, OK 74078, USA
| | - James Portner
- College of Social Work, The Ohio State University, Columbus, OH 43210, USA
| | - Menglin Xu
- The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Lindy Weaver
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Keeley Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Amy Darragh
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Colleen K. Spees
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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22
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Yan Z, Peacock J, Cohen JFW, Kurdziel L, Benes S, Oh S, Bowling A. An 8-Week Peer Health Coaching Intervention among College Students: A Pilot Randomized Study. Nutrients 2023; 15:nu15051284. [PMID: 36904282 PMCID: PMC10005245 DOI: 10.3390/nu15051284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
This study explored the effects of an 8-week peer coaching program on physical activity (PA), diet, sleep, social isolation, and mental health among college students in the United States. A total of 52 college students were recruited and randomized to the coaching (n = 28) or the control group (n = 24). The coaching group met with a trained peer health coach once a week for 8 weeks focusing on self-selected wellness domains. Coaching techniques included reflective listening, motivational interviews, and goal setting. The control group received a wellness handbook. PA, self-efficacy for eating healthy foods, quality of sleep, social isolation, positive affect and well-being, anxiety, and cognitive function were measured. No interaction effects between time and group were significant for the overall intervention group (all p > 0.05), while the main effects of group difference on moderate PA and total PA were significant (p < 0.05). Goal-specific analysis showed that, compared to the control group, those who had a PA goal significantly increased vigorous PA Metabolic Equivalent of Task (METs) (p < 0.05). The vigorous METs for the PA goal group increased from 1013.33 (SD = 1055.12) to 1578.67 (SD = 1354.09); the control group decreased from 1012.94 (SD = 1322.943) to 682.11 (SD = 754.89); having a stress goal significantly predicted a higher post-coaching positive affect and well-being, controlling the pre-score and other demographic factors: B = 0.37 and p < 0.05. Peer coaching showed a promising effect on improving PA and positive affect and well-being among college students.
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Affiliation(s)
- Zi Yan
- Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
- Correspondence: ; Tel.: +1-(978)-837-5435
| | - Jessica Peacock
- Department of Exercise Sciences and Rehabilitation, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
| | - Juliana F. W. Cohen
- Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
| | - Laura Kurdziel
- Department of Psychology and Neuroscience, Merrimack College, North Andover, MA 01845, USA
| | - Sarah Benes
- Department of Health and Movement Science, Southern Connecticut State University, New Haven, CT 06515, USA
| | - Seungbin Oh
- Mental Health Counseling & Behavioral Medicine Program, Department of Psychiatry and Graduate Medical Sciences, Boston University School of Medicine, Boston, MA 02118, USA
| | - April Bowling
- Department of Public Health and Nutrition, School of Nursing and Health Sciences, Merrimack College, North Andover, MA 01845, USA
- Department of Psychiatry, University of Massachusetts TH Chan Medical School, 55 N Lake Ave., Worcester, MA 01655, USA
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23
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van Dijk ML, te Loo LM, Vrijsen J, van den Akker-Scheek I, Westerveld S, Annema M, van Beek A, van den Berg J, Boerboom AL, Bouma A, de Bruijne M, Crasborn J, van Dongen JM, Driessen A, Eijkelenkamp K, Goelema N, Holla J, de Jong J, de Joode A, Kievit A, Klooster JV, Kruizenga H, van der Leeden M, Linders L, Marks-Vieveen J, Mulder DJ, Muller F, van Nassau F, Nauta J, Oostvogels S, Oude Sogtoen J, van der Ploeg HP, Rijnbeek P, Schouten L, Schuling R, Serné EH, Smuling S, Soeters MR, Verhagen EALM, Zwerver J, Dekker R, van Mechelen W, Jelsma JGM. LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol. Trials 2023; 24:114. [PMID: 36803271 PMCID: PMC9936650 DOI: 10.1186/s13063-022-06960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/25/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION ISRCTN ISRCTN13046877 . Registered 21 April 2022.
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Affiliation(s)
- Marlinde L. van Dijk
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, VU University Medical Center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie M. te Loo
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Joyce Vrijsen
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Westerveld
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Annema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - André van Beek
- grid.4494.d0000 0000 9558 4598Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jip van den Berg
- grid.4494.d0000 0000 9558 4598Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L. Boerboom
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrie Bouma
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine de Bruijne
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jeroen Crasborn
- grid.491477.80000 0004 4907 7789Health Insurance Expertise (formerly Zilveren Kruis), Utrecht, The Netherlands
| | - Johanna M. van Dongen
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anouk Driessen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin Eijkelenkamp
- grid.4494.d0000 0000 9558 4598Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nies Goelema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - Jasmijn Holla
- grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands ,grid.418029.60000 0004 0624 3484Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Johan de Jong
- grid.411989.c0000 0000 8505 0496Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Anoek de Joode
- grid.4494.d0000 0000 9558 4598Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arthur Kievit
- grid.7177.60000000084992262Department of Orthopedics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Josine van’t Klooster
- grid.4494.d0000 0000 9558 4598Department of Strategy, Development and External Relations, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hinke Kruizenga
- grid.509540.d0000 0004 6880 3010Department of Nutrition & Dietetics, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Marike van der Leeden
- grid.16872.3a0000 0004 0435 165XDepartment of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
| | - Lilian Linders
- grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jenny Marks-Vieveen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Douwe Johannes Mulder
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Femmy Muller
- grid.491477.80000 0004 4907 7789Zilveren Kruis, Leiden, The Netherlands
| | - Femke van Nassau
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joske Nauta
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - Hidde P. van der Ploeg
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Linda Schouten
- Team Sportservice Noord-Holland, Haarlem, The Netherlands
| | - Rhoda Schuling
- grid.411989.c0000 0000 8505 0496Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Erik H. Serné
- grid.509540.d0000 0004 6880 3010Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Simone Smuling
- Huis voor de Sport in Groningen, Groningen, The Netherlands
| | - Maarten R. Soeters
- grid.7177.60000000084992262Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Evert A. L. M. Verhagen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johannes Zwerver
- grid.4494.d0000 0000 9558 4598Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.415351.70000 0004 0398 026XSports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Rienk Dekker
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willem van Mechelen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith G. M. Jelsma
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Clifford B, Van Gordon K, Magee F, Malone V, Siefried KJ, Graham D, Ezard N. "There's a big tag on my head": exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia. BMC Health Serv Res 2023; 23:162. [PMID: 36793060 PMCID: PMC9933255 DOI: 10.1186/s12913-023-09125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Australia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment. METHODS We conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software. RESULTS Three themes were developed from participants' responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services. CONCLUSION Gender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.
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Affiliation(s)
- Brendan Clifford
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
- National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia.
- Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales, Australia.
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia.
| | - Kate Van Gordon
- Victor Medical Centre, Victor Harbor, South Australia, Australia
| | - Fiona Magee
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Victoria Malone
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Krista J Siefried
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Duncan Graham
- National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia
| | - Nadine Ezard
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales, Australia
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
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25
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Richard BO, Abadi MH, Drake CD, Rychener D, Bauer R. "A reinstilled hope that they can change": Facilitator perspectives on a self-care and health promotion peer group program for veterans. Front Public Health 2023; 10:968281. [PMID: 36684905 PMCID: PMC9851664 DOI: 10.3389/fpubh.2022.968281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction This study assessed the relevance, value, and effectiveness of "Taking Charge of My Life and Health" (TCMLH), a patient wellbeing peer group program for U.S. veterans focused on empowering them to identify what really matters in their lives and to work toward health goals that align with their mission, aspirations, or purpose in life. The potential of TCMLH to empower veterans to engage in self-care behaviors, make health behavior changes, and participate in health care decision making is important, as veterans are more likely than the general population to suffer from multiple chronic conditions that require ongoing self-management. Methods We conducted individual semi-structured interviews with 19 TCMLH facilitators serving in eight U.S. Veteran's Health Administration medical centers. Data were analyzed using an inductive approach to identify salient themes in facilitators' experiences. Results Facilitators reported that TCMLH participants demonstrated positive attitude changes (e.g., greater confidence and hope) and behavior changes (e.g., making healthcare appointments and implementing self-care practices) by program completion. Further, findings show that mindful awareness practices, the peer group setting, Whole Health assessment tools, and goal setting tools were perceived as the most impactful program elements leading to positive health behavior change. Conclusion Overall, findings suggest that this non-clinical peer group program can enhance patient wellbeing, and that there are certain program elements of TCMLH that are driving key attitudinal and behavioral changes.
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Affiliation(s)
- Bonnie O. Richard
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, United States
| | - Melissa H. Abadi
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, United States
| | - Connor D. Drake
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - David Rychener
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, United States
| | - Rachel Bauer
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, United States
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26
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Morse AK, Sercombe J, Askovic M, Fisher A, Marel C, Chatterton ML, Kay-Lambkin F, Barrett E, Sunderland M, Harvey L, Peach N, Teesson M, Mills KL. Systematic review of the efficacy, effectiveness, and cost-effectiveness of stepped-care interventions for the prevention and treatment of problematic substance use. J Subst Abuse Treat 2023; 144:108928. [PMID: 36370469 DOI: 10.1016/j.jsat.2022.108928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 09/15/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stepped-care is a commonly recommended and implemented care model across health care domains, including substance use. Despite their presumed efficient allocation of treatment resources, a current and robust evidence synthesis is needed on the efficacy, effectiveness and cost-effectiveness of stepped-care for substance use. METHODS This systematic review analyzed articles describing evaluations of stepped-care models that measured the use of acutely psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in participants over 18 years old. The analysis investigated model and participant characteristics associated with treatment outcomes. RESULTS The study team conducted a search of five databases of literature (PsychINFO, MEDLINE, Embase, Cochrane Library and Scopus) published between January 1, 2010, and November 1, 2020. The search yielded 1051 unique articles, 19 of which were included in the analysis. The studies had considerable variability in sample sizes (n = 18-2310), time to follow-up (4.5 months to 3 years), and retention rates (35.1-100 %). Studies examined outcomes for either alcohol alone (n = 9), alcohol and other drug use (n = 9), or drug use alone (n = 1). Most studies (n = 13;) were rated as good quality. Three (15.8 %) were rated as fair and three (15.8 %) were rated as poor quality. The evidence regarding the efficacy, effectiveness and cost-effectiveness of stepped-care approaches is limited, but four of seven studies found that adaptive-care interventions delivered in the context of other systemic interventions produced greater benefit than control conditions in relation to at least one alcohol-related outcome. We have insufficient evidence to determine whether the modes or intensity of interventions included in the models, or decision rules used to step people up or down to differing levels of care, have an impact on outcome. CONCLUSION Heterogeneity between studies with regard to model and evaluation design limited the degree to which the analysis could draw robust conclusions. Sample recruitment and statistical power are particular challenges, and the field needs more innovative evaluation designs to assess the efficacy, effectiveness, and cost-effectiveness of stepped-care models.
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Affiliation(s)
- Ashleigh K Morse
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Jayden Sercombe
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Mina Askovic
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Alana Fisher
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Mary-Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong Waterfront Campus, Locked Bag 20001, Geelong, VIC 3220, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle Callaghan NSW 2308, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Logan Harvey
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Natalie Peach
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia.
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27
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Lönnberg L, Damberg M, Revenäs Å. Lifestyle counselling – a long-term commitment based on partnership. BMC PRIMARY CARE 2022; 23:35. [PMID: 35232396 PMCID: PMC8889657 DOI: 10.1186/s12875-022-01642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
Background Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers. Objective The overall aim of this study was to explore patients´ and community health nurses´(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits. Methods Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51–75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. Results The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit. Conclusion The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change. Practice implications A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.
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28
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Lewinski AA, Jazowski SA, Goldstein KM, Whitney C, Bosworth HB, Zullig LL. Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review. PATIENT EDUCATION AND COUNSELING 2022; 105:3381-3388. [PMID: 36002348 PMCID: PMC9675717 DOI: 10.1016/j.pec.2022.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Clinical inertia, the absence of treatment initiation or intensification for patients not achieving evidence-based therapeutic goals, is a primary contributor to poor clinical outcomes. Effectively combating clinical inertia requires coordinated action on the part of multiple representatives including patients, clinicians, health systems, and the pharmaceutical industry. Despite intervention attempts by these representatives, barriers to overcoming clinical inertia in cardiovascular disease (CVD) risk factor control remain. METHODS We conducted a narrative literature review to identify individual-level and multifactorial interventions that have been successful in addressing clinical inertia. RESULTS Effective interventions included dynamic forms of patient and clinician education, monitoring of real-time patient data to facilitate shared decision-making, or a combination of these approaches. Based on findings, we describe three possible multi-level approaches to counter clinical inertia - a collaborative approach to clinician training, use of a population health manager, and use of electronic monitoring and reminder devices. CONCLUSION To reduce clinical inertia and achieve optimal CVD risk factor control, interventions should consider the role of multiple representatives, be feasible for implementation in healthcare systems, and be flexible for an individual patient's adherence needs. PRACTICE IMPLICATIONS Representatives (e.g., patients, clinicians, health systems, and the pharmaceutical industry) could consider approaches to identify and monitor non-adherence to address clinical inertia.
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Affiliation(s)
- Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Duke University School of Nursing, Box 3322 DUMC, Durham, NC 27710, USA.
| | - Shelley A Jazowski
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599‑7400, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA; Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 1200, Nashville, TN 37203, USA.
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, Durham, NC 27701, USA.
| | - Colette Whitney
- Cascades East Family Medicine Residency, Oregon Health & Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Duke University School of Nursing, Box 3322 DUMC, Durham, NC 27710, USA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC 27599‑7400, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, P.O. Box 102508, Durham, NC 27710, USA.
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Attn: HSR&D COIN (558/152), 508 Fulton Street, Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA.
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Petros R, Lapham J, Wierman Rubin B, De Fries SA. Supporting Clinical Development Through Integrative Continuing Education for Field Instructors. CLINICAL SOCIAL WORK JOURNAL 2022; 51:131-142. [PMID: 36465476 PMCID: PMC9702937 DOI: 10.1007/s10615-022-00857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/12/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Field education is the signature pedagogy of social work education, but there is no standardized mechanism to ensure field instructors are trained in the same clinical modalities as social work students or are well-trained in the provision of clinical supervision. Feasibility was assessed of providing field instructors (n = 9) with a continuing education (CE) program to train them in a specialized evidence-based practice, motivational interviewing (MI) in a recovery context, and strategies for supervision. Participants of the CE program gained confidence (p < .05) and knowledge in the spirit (p < .01) and skills (p < .001) of MI; while participants described initial reactions of disdain when role-plays were introduced in the training, they ultimately identified role-plays and facilitator modeling as key features in producing their own practice change and mimicked the use of parallel process - using MI as a way to teach MI - in their provision of supervision. Findings suggest that offering a CE program to train field instructors in a specialized evidence-based practice embedded in course work and strategies for supervision is feasible and may result in enhanced supervision in field education.
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Affiliation(s)
- Ryan Petros
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
| | - Jessica Lapham
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
| | - Beth Wierman Rubin
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
| | - Stacey A. De Fries
- School of Social Work, University of Washington, 4101 15th Ave NE, 98105 Seattle, WA USA
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The Effect of Face-to-Face and Phone Call Motivational Interviewing on Cervical Cancer Screening. Cancer Nurs 2022; 45:E897-E902. [PMID: 35398854 DOI: 10.1097/ncc.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Having regular screening tests largely depends on motivational factors. Motivational interviewing (MI) facilitates the movement through the stages of the transtheoretical model of change. OBJECTIVE The aim of this study was to compare the effect of face-to-face and phone call MI on cervical cancer screening. METHODS This experimental study was conducted on 150 eligible women referred to health centers in Tabriz, Iran. The women were assigned into 3 groups (face-to-face MI, phone MI, or control) using blocked randomization. The face-to-face MI group participated in 3 weekly group counseling sessions, and the motivational phone call group received 3 weekly phone calls. The participants completed the demographic and obstetric questionnaire and stages of change checklist. Adherence to Pap smear was checked, according to the health profile, 6 months after the intervention. The data were analyzed using SPSS 24 software. Chi-square, homogeneity test, and sequential logistic regression by the generalized estimating equations were used. RESULTS After the intervention, about 32% women from the face-to-face MI group, 22% from the motivational phone call group, and 4% from the control group underwent Pap smear screening ( P = .002). There was no significant difference between the 2 interventional groups in Pap smear frequency ( P = .36). CONCLUSION The study results indicated that both face-to-face and phone call MI are effective in motivating women to have a Pap smear. Further studies are recommended to consider long-term follow-up (3-5 years). IMPLICATIONS FOR PRACTICE It is recommended that healthcare providers use motivational phone call to encourage cancer screening behaviors.
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Moodley SV, Wolvaardt J, Grobler C. Enabling mental health task-sharing: a collective case study of undergraduate clinical associate training programmes in South Africa. BMC MEDICAL EDUCATION 2022; 22:745. [PMID: 36307798 PMCID: PMC9615622 DOI: 10.1186/s12909-022-03806-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a shortage of the human resources needed to deliver mental health services which is likely to be exacerbated by COVID-19. Due to mental health workforce shortages, task-shifting and task-sharing approaches have been implemented in a number of countries. Clinical associates, a mid-level cadre working under the supervision of medical practitioners, could play a role in delivering mental health services but it is not clear if they are adequately prepared. This study explored the mental health curriculum content of the undergraduate clinical associate training programmes in South Africa and the views of key informants of the adequacy of training in mental health. METHODS A qualitative collective case study approach was utilised for this multisite study at the three universities in South Africa offering clinical associate degrees. The study consisted of in-depth interviews utilising videoconferencing of individuals involved in each programme and a document review. Thematic analysis of the data was conducted. RESULTS Nineteen interviews were conducted. Mental health formed part of the curriculum in all three programmes with the bulk of the training taking place in the final year of the three-year degree. Facility-based training ranged from two weeks to four weeks with one university only using hospitals with mental health units while two universities used hospitals at which the students were based for the year regardless of potential mental health exposure they would receive. The list of curricula inclusions extended to seldom-seen conditions. The quality of training and supervision appeared site-dependant and only one university set minimum experiential targets. CONCLUSION There is a basis on which to build the competencies and skills regarding mental health in this cadre. A training model that integrates mental health early in the undergraduate curriculum, focuses on common conditions and those with high disease burden, includes time in a mental health unit, provides facility-based trainers with detailed guidance to improve standardisation, and includes specific experiential targets that are monitored will enhance the potential utility of this cadre.
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Affiliation(s)
| | - Jacqueline Wolvaardt
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Christoffel Grobler
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Borge CR, Larsen MH, Osborne RH, Engebretsen E, Andersen MH, Holter IA, Wahl AK. How to co-design a health literacy-informed intervention based on a needs assessment study in chronic obstructive pulmonary disease. BMJ Open 2022; 12:e063022. [PMID: 36302571 PMCID: PMC9621159 DOI: 10.1136/bmjopen-2022-063022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop a co-designed health literacy (HL)-informed intervention for people with chronic obstructive pulmonary disease (COPD) that enables them to find, understand, remember, use and communicate the health information needed to promote and maintain good health. DESIGN This study used a co-design approach informed by the programme logic of the Ophelia (Optimising Health Literacy and Access) process. The co-design included workshops where possible solutions for an HL-informed intervention were discussed based on an HL needs assessment study. SETTINGS Five workshops were performed in a local community setting in the specialist and municipality healthcare services in Oslo, Norway. PARTICIPANTS People with COPD, multidisciplinary healthcare professionals (HCPs) from the municipality and specialist healthcare services, and researchers (n=19) participated in the workshops. The co-designed HL-informed intervention was based on seven focus groups with people with COPD (n=14) and HCPs (n=21), and a cross-sectional study of people with COPD using the Health Literacy Questionnaire (n=69). RESULTS The workshop co-design process identified 45 action points and 51 description points for possible intervention solutions to meet the HL needs of people with COPD. The final recommendation for an HL-informed intervention focused on tailored follow-up after hospitalisation, which uses motivational interviewing techniques, is based on the individual's HL, self-management and quality of life needs and is implemented in cooperation with HCPs in both the specialist and municipality healthcare services. CONCLUSION During the codesign process, the workshop group generated several ideas for how to help patients find, understand, remember, use and communicate health information in order to promote and maintain good health. People with COPD need tailored follow-up based on their individual HL needs by HCPs that have knowledge of COPD and are able to motivate them for self-management tasks and help them to improve their quality of life (QOL) and decrease hospitalisation.
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Affiliation(s)
- Christine Råheim Borge
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
- Research Department, Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Marit Helen Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
- Division of Cancer Medicine, Surgery and Transplantation, Oslo Universitetssykehus, Oslo, Norway
| | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
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Merz EL, Gholizadeh S. Mental and Physical Health Concerns in the Context of COVID-19: Opportunities and Applications for Behavioral Medicine. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:292-300. [PMID: 37205014 PMCID: PMC10172526 DOI: 10.1176/appi.focus.20220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Numerous physical and mental health concerns have been documented in the context of COVID-19, and it is likely that patients, survivors, frontline health care workers, and other affected individuals will present to psychiatry for treatment. Behavioral medicine, an interdisciplinary field that is defined by a behavioral and biomedical conceptualization of clinical care, offers an opportunity for collaboration with psychiatry and other health care providers to meet the myriad needs resulting from the pandemic. This review summarizes a conceptual framework of behavioral medicine and clinical health psychology, COVID-19-related quality of life concerns that may be applicable to behavioral medicine referrals, clinical assessment directions, and intervention opportunities. The review combines both findings specific to COVID-19 and general behavioral medicine principles with an overall goal of providing a basic introduction to behavioral medicine practice, applications, and opportunities for management of medical and psychological symptoms.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, College of Natural and Behavioral Sciences, California State University, Dominguez Hills, Carson (Merz); TheKey Research Group™, San Diego (Gholizadeh)
| | - Shadi Gholizadeh
- Department of Psychology, College of Natural and Behavioral Sciences, California State University, Dominguez Hills, Carson (Merz); TheKey Research Group™, San Diego (Gholizadeh)
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Gwadz M, Cleland CM, Lizardo M, Hawkins RL, Bangser G, Parameswaran L, Stanhope V, Robinson JA, Karim S, Hollaway T, Ramirez PG, Filippone PL, Ritchie AS, Banfield A, Silverman E. Using the multiphase optimization strategy (MOST) framework to optimize an intervention to increase COVID-19 testing for Black and Latino/Hispanic frontline essential workers: A study protocol. BMC Public Health 2022; 22:1235. [PMID: 35729622 PMCID: PMC9210062 DOI: 10.1186/s12889-022-13576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Among those at highest risk for COVID-19 exposure is the large population of frontline essential workers in occupations such food service, retail, personal care, and in-home health services, among whom Black and Latino/Hispanic persons are over-represented. For those not vaccinated and at risk for exposure to COVID-19, including frontline essential workers, regular (approximately weekly) COVID-19 testing is recommended. However, Black and Latino/Hispanic frontline essential workers in these occupations experience serious impediments to COVID-19 testing at individual/attitudinal- (e.g., lack of knowledge of guidelines), social- (e.g., social norms), and structural-levels of influence (e.g., poor access), and rates of testing for COVID-19 are insufficient. METHODS/DESIGN The proposed community-engaged study uses the multiphase optimization strategy (MOST) framework and an efficient factorial design to test four candidate behavioral intervention components informed by an integrated conceptual model that combines critical race theory, harm reduction, and self-determination theory. They are A) motivational interview counseling, B) text messaging grounded in behavioral economics, C) peer education, and D) access to testing (via navigation to an appointment vs. a self-test kit). All participants receive health education on COVID-19. The specific aims are to: identify which components contribute meaningfully to improvement in the primary outcome, COVID-19 testing confirmed with documentary evidence, with the most effective combination of components comprising an "optimized" intervention that strategically balances effectiveness against affordability, scalability, and efficiency (Aim 1); identify mediators and moderators of the effects of components (Aim 2); and use a mixed-methods approach to explore relationships among COVID-19 testing and vaccination (Aim 3). Participants will be N = 448 Black and Latino/Hispanic frontline essential workers not tested for COVID-19 in the past six months and not fully vaccinated for COVID-19, randomly assigned to one of 16 intervention conditions, and assessed at 6- and 12-weeks post-baseline. Last, N = 50 participants will engage in qualitative in-depth interviews. DISCUSSION This optimization trial is designed to yield an effective, affordable, and efficient behavioral intervention that can be rapidly scaled in community settings. Further, it will advance the literature on intervention approaches for social inequities such as those evident in the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov: NCT05139927 ; Registered on 11/29/2021. Protocol version 1.0. May 2, 2022, Version 1.0.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA.
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
- Division of Biostatistics, Department of Population Health at NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Robert L Hawkins
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Greg Bangser
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Lalitha Parameswaran
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Victoria Stanhope
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Jennifer A Robinson
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Shristi Karim
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Tierra Hollaway
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Paola G Ramirez
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Prema L Filippone
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | | | - Elizabeth Silverman
- SUNY Research Foundation, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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Laroche HH, Park-Mroch J, O’Shea A, Rice S, Cintron Y, Engebretsen B. Resource mobilization combined with motivational interviewing to promote healthy behaviors and healthy weight in low-income families: An intervention feasibility study. SAGE Open Med 2022; 10:20503121221102706. [PMID: 35707344 PMCID: PMC9189556 DOI: 10.1177/20503121221102706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives This non-randomized pilot trial examined the feasibility and acceptability of an intervention for low-income families with one parent with obesity, glucose intolerance and/or diabetes. Methods The 12-month intervention combined health coaching using motivational interviewing to promote lifestyle behavior change and community resource mobilization to assist with basic needs plus diet quality and physical activity. Outcome measures included process measures, open-ended questions, and the Family Nutrition and Physical Activity scale. Results Forty-five families completed an average of 2.1 health coach in-person visits, including 15 families lost to follow-up. Parents who stayed in the intervention reported the intervention was helpful. Some families and the health coach had difficulties contacting one another, and some of these families reported they would have liked more sessions with the coach. The Family Nutrition and Physical Activity scores improved significantly for all children (6 months: 2.9; p < .01; 12 months: 3.2; p < .05) and at 6 months for index children (6 months: 3.5; p < .01; 12 months: 2.9; p = .09). There was variation in the FNPA and other outcome changes between families. Conclusion This intervention was feasible in terms of recruitment and delivery of family sessions and community referrals and acceptable to participants, but maintaining contact with participants was difficult. Findings warrant improvements to help retention and logistical aspects of communication between families and coaches and testing in a randomized, controlled trial.
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Affiliation(s)
- Helena H Laroche
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO, USA
- Children’s Mercy Hospital and Clinics, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri–Kansas City, Kansas City, MO, USA
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jennifer Park-Mroch
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
- Health & Well-Being, University of Wisconsin–Extension, Madison, WI, USA
| | - Amy O’Shea
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
- Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Sarai Rice
- Des Moines Area Religious Council (DMARC), Des Moines, IA, USA
| | - Yolanda Cintron
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
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Garcini LM, Venta A, Mercado A, Galvan T, Compean CL, Guerrero G, Rodríguez MMD. One more wall to cross: The role of psychologists in addressing integrated health among undocumented Latinx immigrants in inpatient medical settings. Psychotherapy (Chic) 2022; 59:284-295. [PMID: 35025568 PMCID: PMC9177503 DOI: 10.1037/pst0000381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past decade, there has been increased attention to the benefits of an integrated health-care care model in which psychologists play a vital role collaborating with other health providers to deliver services in inpatient medical settings, such as emergency departments and acute care medical units. Psychologists working in inpatient medical settings can facilitate access to mental health services and referrals, reduce mental health stigma, improve health outcomes associated with insight into psychosocial factors that affect health and illness, improve communication between patients and providers, and increase sensitivity in addressing the health needs of diverse patients. Psychological services in inpatient medical units can be particularly valuable for marginalized populations, such as undocumented Latinx immigrants, who may not otherwise have access to services that can address the compounded effect that psychosocial stressors may have on their physical health. We illustrate the critical role that psychologists can play in inpatient medical settings to address the complex health needs of Latinx immigrants. In this case study, an undocumented young woman presented to an emergency department with acute liver failure. We focus on psychologists' specific contributions as part of the integrated medical team and how it may have impacted treatment effectiveness. We also provide practical assessment and treatment recommendations, along with proposing advocacy efforts to facilitate access to culture and context sensitive treatments for undocumented immigrants with complex health issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Luz M. Garcini
- University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, Department of Medicine
| | | | - Alfonso Mercado
- University of Texas Rio Grande Valley, Department of Psychological Science
| | - Thania Galvan
- University of Denver, Department of Psychology
- University of Illinois, Institute for Juvenile Research
| | - Casandra L. Compean
- University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, Department of Medicine
| | - Gabriela Guerrero
- University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, Department of Medicine
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Long NN, Lau MPXL, Lee ARYB, Yam NE, Koh NYK, Ho CSH. Motivational Interviewing to Improve the Uptake of Colorectal Cancer Screening: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:889124. [PMID: 35559348 PMCID: PMC9090440 DOI: 10.3389/fmed.2022.889124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Colorectal cancer screening when done early can significantly reduce mortality. However, screening compliance is still lower than expected even in countries with established screening programs. Motivational interviewing is an approach that has been explored to promote behavioral change including screening compliance. This review synthesizes the efficacy of motivational interviewing in promoting uptake of colorectal screening modalities and is the only review so far that examines motivational interviewing for colorectal cancer screening alone. Methods A systematic review and meta-analysis was conducted to examine the effects of motivational interviewing for colorectal cancer screening. PubMed, EMBASE, CENTRAL, PsycINFO, and CINAHL were searched to identify eligible studies from inception to June 2021 and selection criteria was defined. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The DerSimonian and Laird random effects model was used in the statistical analysis for studies included in the meta-analysis. Results Fourteen studies from 14 randomized-controlled trials with a low to moderate risk of bias were analyzed. 8 studies in the systematic review showed that motivational interviewing is superior to a control group. Meta-analysis was conducted on 11 studies and showed that motivational interviewing is statistically significant in increasing colorectal cancer screening rates in both intention-to-treat and per-protocol analysis. Timing of data collection of colorectal cancer screening rates did not make a significant difference to the efficacy of motivational interviewing. Studies that offered and accepted a mixture of colorectal screening modalities such as colonoscopy and fecal immunochemical tests were significantly more likely to have favorable colorectal screening outcomes. Heterogeneity in intervention was noted between studies, specifically differences in the training of interventionists, intervention delivery and comparator components. Conclusion Motivational interviewing is a tailored intervention demonstrating mixed evidence in improving colorectal cancer screening attendance amongst individuals. More research is needed to rigorously compare the effect of motivational interviewing alone vs. in combination with other screening promotion strategies to enhance colorectal cancer screening compliance.
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Affiliation(s)
- Novia Niannian Long
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | | | - Natalie Elizabeth Yam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Ye Kai Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Clary KL, Campbell C, Chiu C. Qualitatively Exploring Mental Health Attitude Changes among Emerging Adult Motivational Interviewing after One Motivational Enhanced Interview. CLINICAL SOCIAL WORK JOURNAL 2022; 50:445-457. [PMID: 35493776 PMCID: PMC9028893 DOI: 10.1007/s10615-022-00837-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 05/30/2023]
Abstract
UNLABELLED Emerging adult military members and veterans (MMV) are experiencing many transitions (e.g., adulthood, military). The sum of these changes can cause stress, anxiety, and mental health challenges. Stigma of mental health and treatment exists, and military populations are often not seeking or engaging in appropriate care. Recent research emphasizes the need to uncover mental health attitudes and self-stigma barriers regarding help seeking. We evaluated the impact of a single motivational-interviewing enhanced interview with 26 MMV, all who reported high risk substance use. In 75-minute interviews with the primary focus of discussing their experiences regarding mental health, substance use, and identity development, the interviewer incorporated motivational interviewing strategies (e.g., affirmations, complex reflections). Participants shared their developmental experiences, stressors transitioning, and barriers and stigma around mental health treatment. Participants completed a survey which included a variety of standardized measures and open-ended questions two weeks before and after the interview. Qualitative follow-up data via open ended questions shows the session was well received by participants as they could share their stories, think critically about their military experiences, and brainstorm solutions for mental health care. We conclude that using individual, confidential interviews to discuss sensitive topics for data collection with MMV is an area to continue developing. Conducting qualitative research with motivational interviewing strategies has the potential to be twofold: advance scholarship and inform practitioners, but also serve as a therapeutic platform for some participants. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10615-022-00837-z.
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Affiliation(s)
- Kelly Lynn Clary
- School of Social Work, Texas State University, 601 University Drive; Encino Hall, 78666 San Marcos, TX United States
| | - Corey Campbell
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, United States
| | - Chungyi Chiu
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, United States
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Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study. BMC Public Health 2022; 22:621. [PMID: 35354447 PMCID: PMC8966601 DOI: 10.1186/s12889-022-13024-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/15/2022] [Indexed: 01/02/2023] Open
Abstract
Background Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into office workers' perspectives on physical activity and sedentary behaviour. Methods Sixteen Dutch office workers (50% female) from different professions participated in semi-structured face-to-face interviews in March 2019. To facilitate the interviews, participants received a sensitizing booklet one week before the interview. The booklet aimed to trigger them to reflect on their physical activity and sedentary behaviour and on their values in life. All interviews were audiotaped, transcribed verbatim and coded following codebook thematic analysis. Results Six themes were identified: 1) beliefs about health effects are specific regarding physical activity, but superficial regarding sedentary behaviour; 2) in addition to ‘health’ as a value, other values are also given priority; 3) motivations to engage in physical activity mainly stem from prioritizing the value ‘health’, reflected by a desire to both achieve positive short/mid-term outcomes and to prevent long-term negative outcomes; 4) attitudes towards physical inactivity and sedentary behaviour are diverse and depend on individual values and previous experiences; 5) perceived barriers depend on internal and external factors; 6) supporting factors are related to support and information in the social and physical environment. Conclusions The great value that office workers attach to health is reflected in their motivations and attitudes regarding physical activity. Increasing office workers' knowledge of the health risks of prolonged sitting may therefore increase their motivation to sit less. Although ‘health’ is considered important, other values, including social and work-related values, are sometimes prioritized. We conclude that interventions that aim to reduce sedentary behaviour and increase physical activity among office workers could be improved by informing about health effects of sedentary behaviour and short/mid-term benefits of physical activity, including mental health benefits. Moreover, interventions could frame physical activity as congruent with values and support value-congruent choices. Finally, the work environment could support physical activity and interruption of sedentary behaviour. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13024-z.
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Levy B, Priest A, Delaney T, Hogan J, Herrawi F. Toward Pre-Diagnostic Detection of Dementia in Primary Care. J Alzheimers Dis 2022; 86:479-490. [DOI: 10.3233/jad-215242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Preventing dementia warrants the pragmatic engagement of primary care. Objective: This study predicted conversion to dementia 12 months before diagnosis with indicators that primary care can utilize within the practical constraints of routine practice. Methods: The study analyzed data from the Alzheimer’s Disease Neuroimaging Initiative (Total sample = 645, converting participants = 54). It predicted the conversion from biological (plasma neurofilament light chain), cognitive (Trails Making Test– B), and functional (Functional Activities Questionnaire) measures, in addition to demographic variables (age and education). Results: A Gradient Booster Trees classifier effectively predicted the conversion, based on a Synthetic Minority Oversampling Technique (n = 1,290, F1 Score = 92, AUC = 94, Recall = 87, Precision = 97, Accuracy = 92). Subsequent analysis indicated that the MCI False Positive group (i.e., non-converting participants with cognitive impairment flagged by the model for prospective conversion) scored significantly lower on multiple cognitive tests (Montreal Cognitive Assessment, p < 0.002; ADAS-13, p < 0.0004; Rey Auditory Verbal Learning Test, p < 0.002/0.003) than the MCI True Negative group (i.e., correctly classified non-converting participants with cognitive impairment). These groups also differed in CSF tau levels (p < 0.04), while consistent effect size differences emerged in the all-pairwise comparisons of hippocampal volume and CSF Aβ1 - 42. Conclusion: The model effectively predicted 12-month conversion to dementia and further identified non-converting participants with MCI, in the False Positive group, at relatively higher neurocognitive risk. Future studies may seek to extend these results to earlier prodromal phases. Detection of dementia before diagnosis may be feasible and practical in primary care settings, pending replication of these findings in diverse clinical samples.
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Affiliation(s)
- Boaz Levy
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Amanda Priest
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Tyler Delaney
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jacqueline Hogan
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Farahdeba Herrawi
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
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Baweja R, Soutullo CA, Waxmonsky JG. Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care. World J Psychiatry 2021; 11:1206-1227. [PMID: 35070771 PMCID: PMC8717033 DOI: 10.5498/wjp.v11.i12.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Cesar A Soutullo
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
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Mifsud JL, Galea J. Motivational interviewing and outcomes in primary preventive cardiology. THE BRITISH JOURNAL OF CARDIOLOGY 2021; 28:47. [PMID: 35747071 PMCID: PMC9063703 DOI: 10.5837/bjc.2021.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Joseph Galea
- Associate Professor Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Zullig LL, Shahsahebi M, Neely B, Hyslop T, Avecilla RAV, Griffin BM, Clayton-Stiglbauer K, Coles T, Owen L, Reeve BB, Shah K, Shelby RA, Sutton L, Dinan MA, Zafar SY, Shah NP, Dent S, Oeffinger KC. Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:234. [PMID: 34794388 PMCID: PMC8600877 DOI: 10.1186/s12875-021-01569-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 01/22/2023]
Abstract
Background As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. Methods/Design The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. Discussion As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. Trial registration This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.
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Affiliation(s)
- Leah L Zullig
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
| | - Mohammad Shahsahebi
- Duke University Family Medicine and Community Health, 2424 Erwin Rd, Ste 601, DUMC, Box 2714, Durham, NC, 27705, USA.,Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Benjamin Neely
- Duke Cancer Institute, Duke University, 2424 Erwin Rd, Durham, NC, 27701, USA
| | - Terry Hyslop
- Department of Biostatistics, Duke University, 2424 Erwin Road, 9064 Hock Plaza, Durham, NC, 27705, USA
| | - Renee A V Avecilla
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Brittany M Griffin
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Kacey Clayton-Stiglbauer
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Lynda Owen
- Duke Cancer Network, 20 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Kevin Shah
- Duke Institute for Health Innovation, Duke University Health System, 200 Morris St, Durham, NC, 27701, USA
| | - Rebecca A Shelby
- Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Linda Sutton
- Duke Cancer Network, 20 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Michaela A Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - S Yousuf Zafar
- Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Nishant P Shah
- Duke Heart Center, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Susan Dent
- Duke Cancer Institute, Duke University, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
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Last BS, Buttenheim AM, Futterer AC, Livesey C, Jaeger J, Stewart RE, Reilly M, Press MJ, Peifer M, Wolk CB, Beidas RS. A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care. BMC FAMILY PRACTICE 2021; 22:228. [PMID: 34784899 PMCID: PMC8593851 DOI: 10.1186/s12875-021-01550-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. METHODS This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament-a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. RESULTS The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. CONCLUSIONS Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.
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Affiliation(s)
- Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne C Futterer
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cecilia Livesey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Jaeger
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rebecca E Stewart
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Megan Reilly
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew J Press
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Primary Care Service Line, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maryanne Peifer
- Primary Care Service Line, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA
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Fatkin T, Moore SK, Okst K, Creedon TB, Samawi F, Fredericksen AK, Roll D, Oxnard A, Lê Cook B, Schuman-Olivier Z. Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study. J Subst Abuse Treat 2021; 130:108415. [PMID: 34118705 PMCID: PMC8478704 DOI: 10.1016/j.jsat.2021.108415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
As opioid overdose deaths increase, buprenorphine/naloxone (B/N) treatment is expanding, yet almost half of patients are not retained in B/N treatment. Mindfulness-based interventions (MBIs) designed to promote non-judgmental awareness of present moment experience may be complementary to B/N treatment and offer the potential to enhance retention by reducing substance use and addressing comorbid symptoms. In this pilot study, we examined the feasibility and acceptability of the Mindful Recovery OUD Care Continuum (M-ROCC), a trauma-informed, motivationally sensitive, 24-week MBI. Participants (N = 18) were adults with Opioid Use Disorder prescribed B/N. The study team conducted assessments of satisfaction, mindfulness levels, and home practice, as well as qualitative interviews at 4 and 24-weeks. M-ROCC was feasible in a sample with high rates of childhood trauma and comorbid psychiatric diagnoses with 89% of participants retained at 4-weeks and 72% at 24-weeks. Positive qualitative interview responses and a high rate of participants willing to refer a friend (100%) demonstrates program acceptability. Participant mindfulness increased from baseline to 24-weeks (β = 0.24, p = 0.001, d = 0.51), and increases were correlated with informal mindfulness practice frequency (r = 0.7, p < 0.01). Although limited by small sample size, this pilot study highlights the feasibility and acceptability of integrating MBIs into standard primary care Office-Based Opioid Treatment (OBOT) among a population with substantial trauma history.
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Affiliation(s)
- Thomas Fatkin
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Sarah K Moore
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America.
| | - Kayley Okst
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Timothy B Creedon
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Farah Samawi
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | | | - David Roll
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Alexandra Oxnard
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Benjamin Lê Cook
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Zev Schuman-Olivier
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America; Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America.
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Csillik A, Devulder L, Fenouillet F, Louville P. A pilot study on the efficacy of motivational interviewing groups in alcohol use disorders. J Clin Psychol 2021; 77:2746-2764. [PMID: 34687228 DOI: 10.1002/jclp.23265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The present pilot study was designed to measure the feasibility and efficacy of motivational interviewing (MI) in groups in France, using the Wagner and Ingersoll's method. METHOD Participants (N = 85) were people with an alcohol use disorder (AUD) recruited from addiction consultation centers: 37 received five sessions of 2-h MI groups and 48 were assigned to treatment-as-usual condition (TAU). The sample was middle-aged (M = 43.95, SD = 12.96). RESULTS MI in groups seems to lead to a significant decrease in alcohol use and anxiety and depressive symptoms of participants in the MI condition. Moreover, there seems to be an increase in subjective happiness scores after the MI groups. In addition, participants' reactions were very positive. CONCLUSIONS This study provides encouraging results in favor of the feasibility and efficacy of MI in groups. The use of MI in groups has many advantages in clinical settings.
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Affiliation(s)
- Antonia Csillik
- Department of Psychology, University of Paris Nanterre, Nanterre, France
| | - Laurie Devulder
- Department of Psychology, University of Paris Nanterre, Nanterre, France.,Addictions Unit (ELSA), Hospital Pitié Salpêtrière, Paris, France.,Psychiatry and Addictology Department, Corentin-Celton hospital, AP-HP, Centre - Université de Paris, Issy-les-Moulineaux, France
| | - Fabien Fenouillet
- Department of Psychology, LINP2-AAPS, University of Paris Nanterre, Nanterre, France
| | - Patrice Louville
- Psychiatry and Addictology Department, Corentin-Celton hospital, AP-HP, Centre - Université de Paris, Issy-les-Moulineaux, France
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Khazanov GK, Forbes CN, Dunn BD, Thase ME. Addressing anhedonia to increase depression treatment engagement. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:255-280. [PMID: 34625993 DOI: 10.1111/bjc.12335] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/30/2021] [Indexed: 12/14/2022]
Abstract
Anhedonia, or reward system dysfunction, is associated with poorer treatment outcomes among depressed individuals. The role of anhedonia in treatment engagement, however, has not yet been explored. We review research on components of reward functioning impaired in depression, including effort valuation, reward anticipation, initial responsiveness, reward learning, reward probability, and reward delay, highlighting potential barriers to treatment engagement associated with these components. We then propose interventions to improve treatment initiation and continuation by addressing deficits in each component of reward functioning, focusing on modifications of existing evidence-based interventions to meet the needs of individuals with heightened anhedonia. We describe potential settings for these interventions and times at which they can be delivered during the process of referring individuals to mental health treatment, conducting intakes or assessments, and providing treatment. Additionally, we note the advantages of using screening processes already in place in primary care, workplace, school, and online settings to identify individuals with heightened anhedonia who may benefit from these interventions. We conclude with suggestions for future research on the impact of anhedonia on treatment engagement and the efficacy of interventions to address it. PRACTITIONER POINTS: Many depressed individuals who might benefit from treatment do not initiate it or discontinue early. One barrier to treatment engagement may be anhedonia, a core symptom of depression characterized by loss of interest or pleasure in usual activities. We describe brief interventions to improve treatment engagement in individuals with anhedonia that can be implemented during the referral process or early in treatment. We argue that interventions aiming to improve treatment engagement in depressed individuals that target anhedonia may be particularly effective.
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Affiliation(s)
- Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | | | | | - Michael E Thase
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Rethorn ZD, Bezner JR, Pettitt CD. From expert to coach: health coaching to support behavior change within physical therapist practice. Physiother Theory Pract 2021; 38:2352-2367. [PMID: 34620046 DOI: 10.1080/09593985.2021.1987601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40-50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. Objectives: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. Methods: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. Results: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient's or client's values and strengths to realize their goals for health. Conclusion: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.
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Affiliation(s)
- Zachary D Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.,Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, 601 University Dr, Round Rock, TX, USA
| | - Cherie D Pettitt
- Rocky Mountain University of Health Professions, Provo, UT, USA.,WGU Academy, Western Governors University, Salt Lake City, Ut, USA
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Schaffer KM, Henry ML. Counseling and Care Partner Training in Primary Progressive Aphasia. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:1015-1025. [PMID: 35935167 PMCID: PMC9351599 DOI: 10.1044/2021_persp-20-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Individuals with primary progressive aphasia (PPA) experience loss of communication abilities in the context of neurodegenerative disease. Consequently, many individuals with PPA endorse negative psychosocial effects, including social isolation, reduced communication confidence, and depression. Incorporating communication-centered counseling early and often within the speech-language pathology treatment framework is a vital component in holistically addressing the multifaceted ramifications of living with this devastating disorder. Additionally, care partners are key stakeholders in the treatment dynamic. Involving these individuals in the treatment paradigm through care partner training is crucial for facilitating optimal communication in daily life. The purpose of this narrative literature review is to discuss existing research regarding counseling and care partner training in PPA and to outline additional treatment considerations and future research needs in this understudied area. CONCLUSIONS Relative to studies that delineate restitutive speech-language interventions for PPA, the literature pertaining to counseling and care partner training is limited. Available evidence supports the utility of these approaches, which serve as complementary components to restitutive and compensatory speech-language intervention. Additional research is warranted to support generalizability and long-term benefit of these interventions, and to address facets of counseling and care partner training that have not been explored in PPA (e.g., counseling interventions drawing from specific psychotherapeutic traditions; multicultural counseling) or have only been explored to a limited degree (e.g., interventions that jointly provide counseling and partner training).
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Affiliation(s)
- Kristin M. Schaffer
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Dell Medical School, The University of Texas at Austin
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Jo S. Motivational Interviewing to Increase Physical Activity: A Teaching Activity for Exercise Psychology Students. JOURNAL OF SPORT PSYCHOLOGY IN ACTION 2021. [DOI: 10.1080/21520704.2021.1900478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sabrena Jo
- University of Kansas, Lawrence, Kansas, USA
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