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Schenk PM, Wright AJ, West R, Hastings J, Lorencatto F, Moore C, Hayes E, Schneider V, Howes E, Michie S. An ontology of mechanisms of action in behaviour change interventions. Wellcome Open Res 2024; 8:337. [PMID: 38481854 PMCID: PMC10933577 DOI: 10.12688/wellcomeopenres.19489.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/04/2024] Open
Abstract
Background Behaviour change interventions influence behaviour through causal processes called "mechanisms of action" (MoAs). Reports of such interventions and their evaluations often use inconsistent or ambiguous terminology, creating problems for searching, evidence synthesis and theory development. This inconsistency includes the reporting of MoAs. An ontology can help address these challenges by serving as a classification system that labels and defines MoAs and their relationships. The aim of this study was to develop an ontology of MoAs of behaviour change interventions. Methods To develop the MoA Ontology, we (1) defined the ontology's scope; (2) identified, labelled and defined the ontology's entities; (3) refined the ontology by annotating (i.e., coding) MoAs in intervention reports; (4) refined the ontology via stakeholder review of the ontology's comprehensiveness and clarity; (5) tested whether researchers could reliably apply the ontology to annotate MoAs in intervention evaluation reports; (6) refined the relationships between entities; (7) reviewed the alignment of the MoA Ontology with other relevant ontologies, (8) reviewed the ontology's alignment with the Theories and Techniques Tool; and (9) published a machine-readable version of the ontology. Results An MoA was defined as "a process that is causally active in the relationship between a behaviour change intervention scenario and its outcome behaviour". We created an initial MoA Ontology with 261 entities through Steps 2-5. Inter-rater reliability for annotating study reports using these entities was α=0.68 ("acceptable") for researchers familiar with the ontology and α=0.47 for researchers unfamiliar with it. As a result of additional revisions (Steps 6-8), 23 further entities were added to the ontology resulting in 284 entities organised in seven hierarchical levels. Conclusions The MoA Ontology extensively captures MoAs of behaviour change interventions. The ontology can serve as a controlled vocabulary for MoAs to consistently describe and synthesise evidence about MoAs across diverse sources.
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Affiliation(s)
- Paulina M Schenk
- Centre for Behaviour Change, University College London, London, England, UK
| | - Alison J Wright
- Centre for Behaviour Change, University College London, London, England, UK
- Institute of Pharmaceutical Science, King's College London, London, England, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, England, UK
| | - Janna Hastings
- Institute for Implementation Science in Health Care, Universitat Zurich, Zürich, Zurich, Switzerland
- School of Medicine, University of St Gallen, St. Gallen, St. Gallen, Switzerland
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, England, UK
| | - Candice Moore
- Centre for Behaviour Change, University College London, London, England, UK
| | - Emily Hayes
- Centre for Behaviour Change, University College London, London, England, UK
| | - Verena Schneider
- Research Department of Epidemiology and Public Health, University College London, London, England, UK
| | - Ella Howes
- Leeds Unit for Complex Intervention Development, University of Leeds, Leeds, England, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, England, UK
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Schlam TR, Baker TB, Piper ME, Cook JW, Smith SS, Zwaga D, Jorenby DE, Almirall D, Bolt DM, Collins LM, Mermelstein R, Fiore MC. What to do after smoking relapse? A sequential multiple assignment randomized trial of chronic care smoking treatments. Addiction 2024; 119:898-914. [PMID: 38282258 PMCID: PMC11098029 DOI: 10.1111/add.16428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
AIM To compare effects of three post-relapse interventions on smoking abstinence. DESIGN Sequential three-phase multiple assignment randomized trial (SMART). SETTING Eighteen Wisconsin, USA, primary care clinics. PARTICIPANTS A total of 1154 primary care patients (53.6% women, 81.2% White) interested in quitting smoking enrolled from 2015 to 2019; 582 relapsed and were randomized to relapse recovery treatment. INTERVENTIONS In phase 1, patients received cessation counseling and 8 weeks nicotine patch. Those who relapsed and agreed were randomized to a phase 2 relapse recovery group: (1) reduction counseling + nicotine mini-lozenges + encouragement to quit starting 1 month post-randomization (preparation); (2) repeated encouragement to quit starting immediately post-randomization (recycling); or (3) advice to call the tobacco quitline (control). The first two groups could opt into phase 3 new quit treatment [8 weeks nicotine patch + mini-lozenges plus randomization to two treatment factors (skill training and supportive counseling) in a 2 × 2 design]. Phase 2 and 3 interventions lasted ≤ 15 months. MEASUREMENTS The study was powered to compare each active phase 2 treatment with the control on the primary outcome: biochemically confirmed 7-day point-prevalence abstinence 14 months post initiating phase 2 relapse recovery treatment. Exploratory analyses tested for phase 3 counseling factor effects. FINDINGS Neither skill training nor supportive counseling (each on versus off) increased 14-month abstinence rates; skills on versus off 9.3% (14/151) versus 5.2% (8/153), P = 0.19; support on versus off 6.6% (10/152) versus 7.9% (12/152), P = 0.73. Phase 2 preparation did not produce higher 14-month abstinence rates than quitline referral; 3.6% (8/220) versus 2.1% [3/145; risk difference = 1.5%, 95% confidence interval (CI) = -1.8-5.0%, odds ratio (OR) = 1.8, 95% CI = 0.5-6.9]. Recycling, however, produced higher abstinence rates than quitline referral; 6.9% (15/217) versus 2.1% (three of 145; risk difference, 4.8%, 95% CI = 0.7-8.9%, OR = 3.5, 95% CI = 1.0-12.4). Recycling produced greater entry into new quit treatment than preparation: 83.4% (181/217) versus 55.9% (123/220), P < 0.0001. CONCLUSIONS Among people interested in quitting smoking, immediate encouragement post-relapse to enter a new round of smoking cessation treatment ('recycling') produced higher probability of abstinence than tobacco quitline referral. Recycling produced higher rates of cessation treatment re-engagement than did preparation/cutting down using more intensive counseling and pharmacotherapy.
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Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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3
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Hebard S, Weaver G, Hansen WB, Ruppert S. Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study. JMIR Form Res 2024; 8:e53665. [PMID: 38607664 PMCID: PMC11053396 DOI: 10.2196/53665] [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: 10/25/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. OBJECTIVE This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. METHODS A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. RESULTS After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. CONCLUSIONS While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.
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Affiliation(s)
| | - GracieLee Weaver
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
| | | | - Scarlett Ruppert
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
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Lee CY, Gordon MJ, Markofski MM, LaVoy EC, Peterson SK, Li L, Fares S, Baum M, Pace M, Walsh D, Ferrajoli A, Basen-Engquist K. Optimization of mHealth behavioral interventions for patients with chronic lymphocytic leukemia: the HEALTH4CLL study. J Cancer Surviv 2024:10.1007/s11764-024-01555-w. [PMID: 38472612 DOI: 10.1007/s11764-024-01555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE This pilot study of a diet and physical activity intervention (HEALTH4CLL) was conducted to reduce fatigue and improve physical function (PF) in patients with chronic lymphocytic leukemia (CLL). METHODS The HEALTH4CLL study used a randomized factorial design based on the multiphase optimization strategy (MOST). Patients received diet, exercise, and body weight management instructional materials plus a Fitbit and were randomized to undergo one of 16 combinations of 4 evidence-based mHealth intervention strategies over 16 weeks. Patients' fatigue, PF, health-related quality of life, behavior changes, and program satisfaction and retention were assessed. Paired t-tests were used to examine changes in outcomes from baseline to follow-up among patients. Factorial analysis of variance examined effective intervention components and their combinations regarding improvement in fatigue and PF scores. RESULTS Among 31 patients, we observed significant improvements in fatigue (+ 11.8; t = 4.08, p = 0.001) and PF (+ 2.6; t = 2.75, p = 0.01) scores. The combination of resistance and aerobic exercise with daily self-monitoring was associated with improved fatigue scores (β = 3.857, SE = 1.617, p = 0.027). Analysis of the individual components of the MOST design demonstrated greater improvement in the PF score with resistance plus aerobic exercise than with aerobic exercise alone (β = 2.257, SE = 1.071, p = 0.048). CONCLUSIONS Combined aerobic and resistance exercise and daily self-monitoring improved PF and reduced fatigue in patients with CLL. IMPLICATIONS FOR CANCER SURVIVORS This pilot study supported the feasibility of a low-touch mHealth intervention for survivors of CLL and provided preliminary evidence that exercising, particularly resistance exercise, can improve their symptoms and quality of life.
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Affiliation(s)
- Che Young Lee
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1440, Houston, TX, 77030, USA
| | - Max J Gordon
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 428, Houston, TX, 77030, USA
| | - Melissa M Markofski
- Department of Health and Human Performance, University of Houston, 3875 Holman St., Rm 104 Garrison, Houston, TX, 77204, USA
| | - Emily C LaVoy
- Department of Health and Human Performance, University of Houston, 3875 Holman St., Rm 104 Garrison, Houston, TX, 77204, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1330, Houston, TX, 77030, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1411, Houston, TX, 77030, USA
| | - Sara Fares
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1440, Houston, TX, 77030, USA
| | - Miranda Baum
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1440, Houston, TX, 77030, USA
| | - Margaret Pace
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 428, Houston, TX, 77030, USA
| | - Danielle Walsh
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 428, Houston, TX, 77030, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 428, Houston, TX, 77030, USA.
| | - Karen Basen-Engquist
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1440, Houston, TX, 77030, USA.
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Nemeth JM, Glasser AM, Macisco J, Hinton A, Wermert A, Patterson JG, Sucaldito A, Gilson C, Kemble H, Garbsch E, Caponi J. Identifying Novel Motivation Phase-Specific Cessation Targets for Youth Experiencing Homelessness in the United States. Nicotine Tob Res 2024; 26:237-244. [PMID: 37725951 PMCID: PMC10803121 DOI: 10.1093/ntr/ntad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Of youth experiencing homelessness (YEH; 14-24 years old), 70%+ smoke combustible, commercial tobacco. Though many have tried to quit, most use ineffective methods. Drop-in centers for YEH are opportune places to link YEH to evidence-based treatment. Using the Phase-Based Model (PBM) for Cessation Research, the aim of this study was to identify "Motivation" phase-specific challenges impacting YEH's willingness to make a quit attempt-the goal of this cessation phase. AIMS AND METHODS Surveys were interview administered with 96 past-week combusted tobacco users accessing drop-in services. Regression models were fit to confirm hypothesized challenges impacting YEH's willingness to quit. RESULTS Moderate nicotine dependence was noted-a key Motivation phase cessation mechanism targeted-and was associated with population challenges including, but not limited to, replacing food with tobacco, accidental oxygen-deprivation events, and smoking to socialize. While 67.1% of participants made a past-year quit attempt, 45.8% expressed 30-day quit interest. Dimensions of coping with housing were associated with quit attempts and quit interest. Quit attempts were also associated with nicotine dependence, working, and smoking to socialize. Whereas, quit interest was associated with less endorsement of smoking to regulate affect and more endorsement to avoid danger. CONCLUSIONS Though common challenges targeted in Motivation phase cessation exist among YEH, other challenges may also need to be addressed to promote quitting. IMPLICATIONS Future research in optimizing evidence-based cessation access for YEH through drop-in centers may consider addressing the challenges of housing, food security, social context, violence, and neurotrauma sequela to bolster YEH willingness to make a quit attempt.
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Affiliation(s)
- Julianna M Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Allison M Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- Institute for Nicotine and Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Joseph Macisco
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Joanne G Patterson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ana Sucaldito
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine and Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carra Gilson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Hannah Kemble
- Division of Health Sciences Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ellen Garbsch
- Division of Health Sciences Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jacob Caponi
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
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Terrana A, Viglione C, Rhee K, Rabin B, Godino J, Aarons GA, Chapman J, Melendrez B, Holguin M, Osorio L, Gidwani P, Juarez Nunez C, Firestein G, Hekler E. The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity. FRONTIERS IN HEALTH SERVICES 2024; 3:1281690. [PMID: 38292916 PMCID: PMC10826509 DOI: 10.3389/frhs.2023.1281690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
There are numerous frameworks for implementing evidence-based practices (EBPs) in novel settings to achieve "fidelity." However, identifying appropriate referents for fidelity poses a challenge. The Core Functions and Forms paradigm offers a model that can inform adaptation decisions throughout all phases of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We applied the Core Functions-Forms paradigm throughout the Exploration and Preparation phases of EPIS in the design of two EBPs targeting family protective factors among Latinos in San Diego, as well as describe plans for its use in Implementation and Sustainment. We employed a distinct approach for each intervention element to contrast adaptation decisions that prioritize adherence to either form or function fidelity. We describe our application of the functions-forms paradigm within the EPIS framework, focusing on the Preparation phase. We also provide functions-forms matrices that map out the relationship between individual intervention components (forms) and the essential processes (functions) by which components are theorized to exert their impact. This case study of how the core functions-forms framework can be mapped onto EPIS can support a conceptual shift from prioritizing form fidelity to also focusing on function fidelity. This might allow interventionists to target appropriate fidelity referents when adapting an EBP, rather than defaulting to maintaining fidelity to forms as described in the protocol. We see great promise for using this framework for guiding actions throughout all EPIS phases and informing future applications of this paradigm to foster more robust fidelity to function.
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Affiliation(s)
- Alec Terrana
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Clare Viglione
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Kyung Rhee
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Borsika Rabin
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| | - Job Godino
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Gregory A. Aarons
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Jessica Chapman
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Blanca Melendrez
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | - Liliana Osorio
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | | | - Gary Firestein
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Eric Hekler
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
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Kimber C, Sideropoulos V, Cox S, Frings D, Naughton F, Brown J, McRobbie H, Dawkins L. E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment. Addiction 2023; 118:2105-2117. [PMID: 37455014 PMCID: PMC10952247 DOI: 10.1111/add.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
AIMS, DESIGN AND SETTING The aim of this study was to determine which combination(s) of five e-cigarette-orientated intervention components, delivered on-line, affect smoking cessation. An on-line (UK) balanced five-factor (2 × 2 × 2 × 2 × 2 = 32 intervention combinations) randomized factorial design guided by the multi-phase optimization strategy (MOST) was used. PARTICIPANTS A total of 1214 eligible participants (61% female; 97% white) were recruited via social media. INTERVENTIONS The five on-line intervention components designed to help smokers switch to exclusive e-cigarette use were: (1) tailored device selection advice; (2) tailored e-liquid nicotine strength advice; (3): tailored e-liquid flavour advice; (4) brief information on relative harms; and (5) text message (SMS) support. MEASUREMENTS The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order. FINDINGS In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13-2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components. CONCLUSIONS Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt.
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Affiliation(s)
| | | | - Sharon Cox
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | - Felix Naughton
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Hayden McRobbie
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
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Sripada RK, Peterson CL, Dziak JJ, Nahum-Shani I, Roberge EM, Martinson AA, Porter K, Grau P, Curtis D, McElroy S, Bryant S, Gracy I, Pryor C, Walters HM, Austin K, Ehlinger C, Sayer N, Wiltsey-Stirman S, Chard K. Using the multiphase optimization strategy to adapt cognitive processing therapy (CPT MOST): study protocol for a randomized controlled factorial experiment. Trials 2023; 24:676. [PMID: 37858262 PMCID: PMC10588087 DOI: 10.1186/s13063-023-07669-3] [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: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Approximately ten percent of US military veterans suffer from posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT) is a highly effective, evidence-based, first-line treatment for PTSD that has been widely adopted by the Department of Veterans Affairs (VA). CPT consists of discrete therapeutic components delivered across 12 sessions, but most veterans (up to 70%) never reach completion, and those who discontinue therapy receive only four sessions on average. Unfortunately, veterans who drop out prematurely may never receive the most effective components of CPT. Thus, there is an urgent need to use empirical approaches to identify the most effective components of CPT so CPT can be adapted into a briefer format. METHODS The multiphase optimization strategy (MOST) is an innovative, engineering-inspired framework that uses an optimization trial to assess the performance of individual intervention components within a multicomponent intervention such as CPT. Here we use a fractional factorial optimization trial to identify and retain the most effective intervention components to form a refined, abbreviated CPT intervention package. Specifically, we used a 16-condition fractional factorial experiment with 270 veterans (N = 270) at three VA Medical Centers to test the effectiveness of each of the five CPT components and each two-way interaction between components. This factorial design will identify which CPT components contribute meaningfully to a reduction in PTSD symptoms, as measured by PTSD symptom reduction on the Clinician-Administered PTSD Scale for DSM-5, across 6 months of follow-up. It will also identify mediators and moderators of component effectiveness. DISCUSSION There is an urgent need to adapt CPT into a briefer format using empirical approaches to identify its most effective components. A brief format of CPT may reduce attrition and improve efficiency, enabling providers to treat more patients with PTSD. The refined intervention package will be evaluated in a future large-scale, fully-powered effectiveness trial. Pending demonstration of effectiveness, the refined intervention can be disseminated through the VA CPT training program. TRIAL REGISTRATION ClinicalTrials.gov NCT05220137. Registration date: January 21, 2022.
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Affiliation(s)
- Rebecca K Sripada
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Psychiatry, University of Michigan, Ann Arbor, USA.
| | - Cassaundra L Peterson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - John J Dziak
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, USA
| | - Inbal Nahum-Shani
- University of Michigan Institute for Social Research, Ann Arbor, USA
| | - Erika M Roberge
- VA Salt Lake City Health Care System, University of Utah School of Medicine, Salt Lake City, USA
| | | | | | - Peter Grau
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Diana Curtis
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | | | - Sarah Bryant
- VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Isabel Gracy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Cosette Pryor
- VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Heather M Walters
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Karen Austin
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | | | - Nina Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA
| | | | - Kathleen Chard
- Cincinnati VA Medical Center, University of Cincinnati, Cincinnati, USA
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9
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Rivera-Romero O, Gabarron E, Ropero J, Denecke K. Designing personalised mHealth solutions: An overview. J Biomed Inform 2023; 146:104500. [PMID: 37722446 DOI: 10.1016/j.jbi.2023.104500] [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: 02/28/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. MATERIALS AND METHODS We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. RESULTS Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self-management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. DISCUSSION Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. CONCLUSIONS Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques.
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Affiliation(s)
- Octavio Rivera-Romero
- Electronic Technology Department, Universidad de Sevilla, Spain; Instituto de Investigación en Informática de la Universidad de Sevilla, Spain.
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Jorge Ropero
- Electronic Technology Department, Universidad de Sevilla, Spain
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10
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Ruehlman L, Karoly P. A pilot test of Internet-delivered brief interactive training sessions for depression: Evaluating dropout, uptake, adherence, and outcome. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2131-2139. [PMID: 34469262 DOI: 10.1080/07448481.2021.1961781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/31/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Uptake, adherence, and dropout rates for Internet-based programs for depression are in need of improvement. Excessive user burden (eg, heavy content, extended duration) may undermine engagement and precipitate dropout. To address this problem, an alternative format was proposed: Brief Interactive Training Sessions (BITS). BITS target a narrow behavioral health skill and require 3-4 hours to complete. A depression-focused version of BITS that provides training in cognitive distortion/restructuring was tested. PARTICIPANTS Fifty-two depressed college students were randomly assigned to BITS or to a wait-list. METHODS Students competed pre-and post-test (7 week) assessments of depression and cognitive distortions. RESULTS Uptake rate was 83%. Among study completers, adherence was 96%. The dropout rate did not improve. Compared to the control group, the experimental group reported a significant reduction in depression and in cognitive distortions. CONCLUSIONS The BITS format is a promising vehicle for improving uptake and adherence while achieving positive clinical outcomes.
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Affiliation(s)
| | - Paul Karoly
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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11
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Francis LA, Nix RL, BeLue R, Keller KL, Kugler KC, Rollins BY, Savage JS. Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project. Clin Trials 2023; 20:434-446. [PMID: 37077032 PMCID: PMC10338696 DOI: 10.1177/17407745231167115] [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] [Indexed: 04/21/2023]
Abstract
BACKGROUND/AIMS Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.
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Affiliation(s)
- Lori A Francis
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Robert L Nix
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Rhonda BeLue
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Kathleen L Keller
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Kari C Kugler
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Brandi Y Rollins
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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O'Donnell HK, Trojanowski PJ, Alonso GT, Majidi S, Snell-Bergeon J, Wadwa RP, Vigers T, Pyle L, Gurka MJ, Shaffer E, Driscoll KA. A randomized controlled clinical trial to improve health outcomes in youth with type 1 diabetes: Study design and baseline characteristics. Contemp Clin Trials 2023; 131:107270. [PMID: 37348599 DOI: 10.1016/j.cct.2023.107270] [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: 12/28/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Most adolescents with T1D do not meet glycemic recommendations or consistently perform the required self-management behaviors to prevent acute- and long-term deleterious health outcomes. In addition, most youth with T1D do not have access to behavioral health services to address T1D management barriers. Thus, delivering behavioral interventions during routine medical appointments may hold promise for improving T1D outcomes in adolescents. The overall objective of this study was to examine the effect of behavioral interventions, either a Personalized T1D Self-Management Behaviors Feedback Report or Problem-Solving Skills, delivered by a T1D behavioral health provider and a T1D medical provider during a joint, fully integrated appointment to improve health outcomes in youth with T1D. This paper describes the study rationale, design, and baseline characteristics for the 109 adolescent-caregiver dyads who participated. Primary and secondary outcomes include hemoglobin A1c (A1C), T1D self-management behaviors, and biological indicators of complications.
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Affiliation(s)
- Holly K O'Donnell
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Paige J Trojanowski
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - G Todd Alonso
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Shideh Majidi
- Children's National, Pediatric Endocrinology, 111 Michigan Ave NW, Washington DC, United States of America.
| | - Janet Snell-Bergeon
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - R Paul Wadwa
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Tim Vigers
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Laura Pyle
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Matthew J Gurka
- University of Florida, College of Medicine, Department of Pediatrics, PO Box 100177, Gainesville, FL, United States of America.
| | - Emily Shaffer
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America.
| | - Kimberly A Driscoll
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America; University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America; University of Florida Diabetes Institute, United States of America.
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13
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Miller TR, Johnson MB, Dziura JD, Weiss J, Carpenter KM, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll BA, Bernstein SL. Cost-Effectiveness of Smoking Cessation Approaches in Emergency Departments. Am J Prev Med 2023; 65:39-44. [PMID: 36710199 PMCID: PMC10293014 DOI: 10.1016/j.amepre.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Americans of lower SES use tobacco products at disproportionately high rates and are over-represented as patients of emergency departments. Accordingly, emergency department visits are an ideal time to initiate tobacco treatment and aftercare for this vulnerable and understudied population. This research estimates the costs per quit of emergency department smoking-cessation interventions and compares them with those of other approaches. METHODS Previously published research described the effectiveness of 2 multicomponent smoking cessation interventions, including brief negotiated interviewing, nicotine replacement therapy, quitline referral, and follow-up communication. Study 1 (collected in 2010-2012) only analyzed the combined interventions. Study 2 (collected in 2017-2019) analyzed the intervention components independently. Costs per participant and per quit were estimated separately, under distinct intervention with dedicated staff and intervention with repurposed staff assumptions. The distinction concerns whether the intervention used dedicated staff for delivery or whether time from existing staff was repurposed for intervention if available. RESULTS Data were analyzed in 2021-2022. In the first study, the cost per participant was $860 (2018 dollars), and the cost per quit was $11,814 (95% CI=$7,641, $25,423) (dedicated) and $227 per participant and $3,121 per quit (95% CI=$1,910, $7,012) (repurposed). In Study 2, the combined effect of brief negotiated interviewing, nicotine replacement therapy, and quitline cost $808 per participant and $6,100 per quit (dedicated) (95% CI=$4,043, $12,274) and $221 per participant and $1,669 per quit (95% CI=$1,052, $3,531) (repurposed). CONCLUSIONS Costs varied considerably per method used but were comparable with those of other smoking cessation interventions.
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Affiliation(s)
- Ted R Miller
- Pacific Institute for Research and Evaluation, Beltsville, Maryland, School of Public Health, Curtin University, Perth, Australia.
| | - Mark B Johnson
- Pacific Institute for Research and Evaluation, Beltsville, Maryland, School of Public Health, Curtin University, Perth, Australia
| | - James D Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
| | - Linda M Collins
- School of Global Public Health, New York University, New Haven, Connecticut
| | - Benjamin A Toll
- Yale Cancer Center, New Haven, Connecticut; Medical University of South Carolina, Charleston, South Carolina
| | - Steven L Bernstein
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire; C. Everett Koop Institute at Dartmouth, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
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Buskbjerg C, O'Toole MS, Zachariae R, Jensen AB, Frederiksen Y, Johansen C, von Heymann A, Speckens A, Johannsen M. Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark. BMJ Open 2023; 13:e066505. [PMID: 36948567 PMCID: PMC10040060 DOI: 10.1136/bmjopen-2022-066505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05444101).
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Affiliation(s)
- Cecilie Buskbjerg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Yoon Frederiksen
- Deparment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Sexology Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maja Johannsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Taylor AH, Thompson TP, Streeter A, Chynoweth J, Snowsill T, Ingram W, Ussher M, Aveyard P, Murray RL, Harris T, Callaghan L, Green C, Greaves CJ, Price L, Creanor S. Effectiveness and cost-effectiveness of behavioural support for prolonged abstinence for smokers wishing to reduce but not quit: Randomised controlled trial of physical activity assisted reduction of smoking (TARS). Addiction 2023; 118:1140-1152. [PMID: 36871577 DOI: 10.1111/add.16129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/13/2022] [Indexed: 03/07/2023]
Abstract
AIMS For smokers unmotivated to quit, we assessed the effectiveness and cost-effectiveness of behavioural support to reduce smoking and increase physical activity on prolonged abstinence and related outcomes. DESIGN A multi-centred pragmatic two-arm parallel randomised controlled trial. SETTING Primary care and the community across four United Kingdom sites. PARTICIPANTS Nine hundred and fifteen adult smokers (55% female, 85% White), recruited via primary and secondary care and the community, who wished to reduce their smoking but not quit. INTERVENTIONS Participants were randomised to support as usual (SAU) (n = 458) versus multi-component community-based behavioural support (n = 457), involving up to eight weekly person-centred face-to-face or phone sessions with additional 6-week support for those wishing to quit. MEASUREMENTS Ideally, cessation follows smoking reduction so the primary pre-defined outcome was biochemically verified 6-month prolonged abstinence (from 3-9 months, with a secondary endpoint also considering abstinence between 9 and 15 months). Secondary outcomes included biochemically verified 12-month prolonged abstinence and point prevalent biochemically verified and self-reported abstinence, quit attempts, number of cigarettes smoked, pharmacological aids used, SF12, EQ-5D and moderate-to-vigorous physical activity (MVPA) at 3 and 9 months. Intervention costs were assessed for a cost-effectiveness analysis. FINDINGS Assuming missing data at follow-up implied continued smoking, nine (2.0%) intervention participants and four (0.9%) SAU participants achieved the primary outcome (adjusted odds ratio, 2.30; 95% confidence interval [CI] = 0.70-7.56, P = 0.169). At 3 and 9 months, the proportions self-reporting reducing cigarettes smoked from baseline by ≥50%, for intervention versus SAU, were 18.9% versus 10.5% (P = 0.009) and 14.4% versus 10% (P = 0.044), respectively. Mean difference in weekly MVPA at 3 months was 81.6 minutes in favour of the intervention group (95% CI = 28.75, 134.47: P = 0.003), but there was no significant difference at 9 months (23.70, 95% CI = -33.07, 80.47: P = 0.143). Changes in MVPA did not mediate changes in smoking outcomes. The intervention cost was £239.18 per person, with no evidence of cost-effectiveness. CONCLUSIONS For United Kingdom smokers wanting to reduce but not quit smoking, behavioural support to reduce smoking and increase physical activity improved some short-term smoking cessation and reduction outcomes and moderate-to-vigorous physical activity, but had no long-term effects on smoking cessation or physical activity.
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Affiliation(s)
| | | | - Adam Streeter
- Faculty of Health, University of Plymouth, Plymouth, UK.,Institut für Epidemiologie und Sozialmedizin, University of Münster, Munster, Germany
| | | | - Tristan Snowsill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Wendy Ingram
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK.,Population Health Research Institute, St. George's University of London, London, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Rachael L Murray
- Lifespan and Population Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tess Harris
- Population Health Research Institute, St. George's University of London, London, UK
| | | | - Colin Green
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Lisa Price
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Siobhan Creanor
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, Escalante CP, Gozal D, Granger CL, Presley CJ, Smith SM, Chamberlaine DM, Long JM, Malone DJ, Pirl WF, Robinson HL, Yasufuku K, Rivera MP. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e6-e28. [PMID: 36856560 PMCID: PMC10870898 DOI: 10.1164/rccm.202210-1963st] [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] [Indexed: 03/02/2023] Open
Abstract
Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.
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Singh N, Varshney U. Adaptive interventions for opioid prescription management and consumption monitoring. J Am Med Inform Assoc 2023; 30:511-528. [PMID: 36562638 PMCID: PMC9933075 DOI: 10.1093/jamia/ocac253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES While opioid addiction, treatment, and recovery are receiving attention, not much has been done on adaptive interventions to prevent opioid use disorder (OUD). To address this, we identify opioid prescription and opioid consumption as promising targets for adaptive interventions and present a design framework. MATERIALS AND METHODS Using the framework, we designed Smart Prescription Management (SPM) and Smart Consumption Monitoring (SCM) interventions. The interventions are evaluated using analytical modeling and secondary data on doctor shopping, opioid overdose, prescription quality, and cost components. RESULTS SPM was most effective (30-90% improvement, for example, prescriptions reduced from 18 to 1.8 per patient) for extensive doctor shopping and reduced overdose events and mortality. Opioid adherence was improved and the likelihood of addiction declined (10-30%) as the response rate to SCM was increased. There is the potential for significant incentives ($2267-$3237) to be offered for addressing severe OUD. DISCUSSION The framework and designed interventions adapt to changing needs and conditions of the patients to become an important part of global efforts in preventing OUD. To the best of our knowledge, this is the first paper on adaptive interventions for preventing OUD by addressing both prescription and consumption. CONCLUSION SPM and SCM improved opioid prescription and consumption while reducing the risk of opioid addiction. These interventions will assist in better prescription decisions and in managing opioid consumption leading to desirable outcomes. The interventions can be extended to other substance use disorders and to study complex scenarios of prescription and nonprescription opioids in clinical studies.
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Affiliation(s)
- Neetu Singh
- Department of Management Information Systems, University of Illinois Springfield, Springfield, Illinois, USA
| | - Upkar Varshney
- Department of Computer Information Systems, Georgia State University, Atlanta, Georgia, USA
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Bernstein SL, Dziura J, Weiss J, Brooks AH, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy. Ann Emerg Med 2023; 81:209-221. [PMID: 36585318 PMCID: PMC9868063 DOI: 10.1016/j.annemergmed.2022.08.018] [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: 06/21/2021] [Revised: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. METHODS We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. RESULTS Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. CONCLUSION The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Center for Implementation Science, New Haven, CT; Yale Cancer Center, New Haven, CT.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Avis H Brooks
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, New Haven, CT; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, PA
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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19
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Tildy BE, McNeill A, Perman-Howe PR, Brose LS. Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies. BMC PRIMARY CARE 2023; 24:32. [PMID: 36698052 PMCID: PMC9875430 DOI: 10.1186/s12875-023-01981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Internationally, there is an 'evidence-practice gap' in the rate healthcare professionals assess tobacco use and offer cessation support in clinical practice, including primary care. Evidence is needed for implementation strategies enacted in the 'real-world'. AIM To identify implementation strategies aiming to increase smoking cessation treatment provision in primary care, their effectiveness, cost-effectiveness and any perceived facilitators and barriers for effectiveness. METHODS 'Embase', 'Medline', 'PsycINFO', 'CINAHL', 'Global Health', 'Social Policy & Practice', 'ASSIA Applied Social Sciences Index and Abstracts' databases, and grey literature sources were searched from inception to April 2021. Studies were included if they evaluated an implementation strategy implemented on a nation-/state-wide scale, targeting any type of healthcare professional within the primary care setting, aiming to increase smoking cessation treatment provision. PRIMARY OUTCOME MEASURES implementation strategy identification, and effectiveness (practitioner-/patient-level). SECONDARY OUTCOME MEASURES perceived facilitators and barriers to effectiveness, and cost-effectiveness. Studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was conducted using the Expert Recommendations for Implementing Change (ERIC) compilation and the Consolidated Framework for Implementation Research (CFIR). RESULTS Of 49 included papers, half were of moderate/low risk of bias. The implementation strategy domains identified involved utilizing financial strategies, changing infrastructure, training and educating stakeholders, and engaging consumers. The first three increased practitioner-level smoking status recording and cessation advice provision. Interventions in the utilizing financial strategies domain also appeared to increase smoking cessation (patient-level). Key facilitator: external policies/incentives (tobacco control measures and funding for public health and cessation clinics). Key barriers: time and financial constraints, lack of free cessation medications and follow-up, deprioritisation and unclear targets in primary care, lack of knowledge of healthcare professionals, and unclear messaging to patients about available cessation support options. No studies assessed cost-effectiveness. CONCLUSIONS Some implementation strategy categories increased the rate of smoking status recording and cessation advice provision in primary care. We found some evidence for interventions utilizing financial strategies having a beneficial impact on cessation. Identified barriers to effectiveness should be reduced. More pragmatic approaches are recommended, such as hybrid effectiveness-implementation designs and utilising Multiphase Optimization Strategy methodology. PROTOCOL REGISTRATION PROSPERO:CRD42021246683.
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Affiliation(s)
- Bernadett E Tildy
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK. .,SPECTRUM Consortium, London, UK.
| | - Ann McNeill
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
| | - Parvati R Perman-Howe
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
| | - Leonie S Brose
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
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20
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Bell IH, Marx W, Nguyen K, Grace S, Gleeson J, Alvarez-Jimenez M. The effect of psychological treatment on repetitive negative thinking in youth depression and anxiety: a meta-analysis and meta-regression. Psychol Med 2023; 53:6-16. [PMID: 36373473 PMCID: PMC9875014 DOI: 10.1017/s0033291722003373] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/14/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression and anxiety are prevalent in youth populations and typically emerge during adolescence. Repetitive negative thinking (RNT) is a putative transdiagnostic mechanism with consistent associations with depression and anxiety. Targeting transdiagnostic processes like RNT for youth depression and anxiety may offer more targeted, personalised and effective treatment. METHODS A meta-analysis was conducted to examine the effect of psychological treatments on RNT, depression and anxiety symptoms in young people with depression or anxiety, and a meta-regression to examine relationships between outcomes. RESULTS Twenty-eight randomised controlled trials examining 17 different psychological interventions were included. Effect sizes were small to moderate across all outcomes (Hedge's g depression = -0.47, CI -0.77 to -0.17; anxiety = -0.42, CI -0.65 to -0.20; RNT = -0.45, CI -0.67 to -0.23). RNT-focused and non-RNT focused approaches had comparable effects; however, those focusing on modifying the process of RNT had significantly larger effects on RNT than those focusing on modifying negative thought content. Meta-regression revealed a significant relationship between RNT and depression outcomes only across all intervention types and with both depression and anxiety for RNT focused interventions only. CONCLUSION Consistent with findings in adults, this review provides evidence that reducing RNT with psychological treatment is associated with improvements in depression and anxiety in youth. Targeting RNT specifically may not lead to better outcomes compared to general approaches; however, focusing on modifying the process of RNT may be more effective than targeting content. Further research is needed to determine causal pathways.
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Affiliation(s)
- Imogen H. Bell
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Wolfgang Marx
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Katherine Nguyen
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sally Grace
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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21
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Kenfield SA, Philip EJ, Phillips SM, Meyerhardt JA, Chan JM, Atreya CE, Kim MO, Harris Q, Steiding P, Macaire G, McCullough ML, Piawah S, Johnson WY, Kurttila FA, Lewis WL, Pesmen C, Watson Y, Van Blarigan EL. Optimizing intervention tools to improve nutrition and physical activity for colorectal cancer survivors (Tools To Be Fit): Study protocol of a randomized factorial experiment. Contemp Clin Trials 2022; 123:107009. [PMID: 36396066 PMCID: PMC10561599 DOI: 10.1016/j.cct.2022.107009] [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: 06/22/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the United States. The American Cancer Society (ACS) Nutrition and Physical Activity Guidelines are associated with longer survival among CRC survivors, but few report behaviors consistent with the guidelines. METHODS The Tools To Be Fit study, based on the Multiphase Optimization Strategy (MOST) framework, is a full factorial experimental to optimize a remotely delivered 48-week diet and physical activity intervention for non-metastatic CRC survivors. The intervention includes a core component (booklet and personal report). CRC survivors (N = 400) are additionally randomly assigned to one of 16 combinations of four candidate components, each with 2 options: 1) text messaging (on/off); 2) self-monitoring modality (digital/paper); 3) health coaching (on/off); and 4) support person coaching (on/off). OUTCOMES Our primary outcome is adherence to the ACS guidelines after 48 weeks using a score that includes physical activity from accelerometers, dietary intake from a food frequency questionnaire, and body mass index (BMI) measured by a technician. Secondary outcomes include the ACS score after 24 weeks and score components at 24 and 48 weeks. Exploratory outcomes include adherence and change in Social Cognitive Theory constructs. We will explore moderation by sociodemographic, clinical, and psychological/behavioral factors; and change in the ACS score in relation to change in levels of insulin, insulin sensitivity, inflammation, gut microbiome structure, fatigue, depression, and sleep disturbance. DISCUSSION The proposed study aims to inform a randomized controlled trial to determine whether an optimized intervention reduces risk of recurrence among CRC survivors.
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Affiliation(s)
- Stacey A Kenfield
- Department of Urology, University of California, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Errol J Philip
- UCSF School of Medicine, University of California, San Francisco, CA, United States of America
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | | | - June M Chan
- Department of Urology, University of California, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Chloe E Atreya
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States of America; Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Mi-Ok Kim
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States of America
| | - Quincy Harris
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States of America
| | - Paige Steiding
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States of America
| | - Greta Macaire
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States of America
| | - Marjorie L McCullough
- Department of Population Science, American Cancer Society, Atlanta, GA, United States of America
| | - Sorbarikor Piawah
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States of America; Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Wenora Y Johnson
- Fight Colorectal Cancer Research Advocate, Springfield, MO, United States of America
| | - Florence A Kurttila
- Fight Colorectal Cancer Research Advocate, Springfield, MO, United States of America
| | - Wendy L Lewis
- Fight Colorectal Cancer Research Advocate, Springfield, MO, United States of America
| | - Curtis Pesmen
- Fight Colorectal Cancer Research Advocate, Springfield, MO, United States of America
| | - Yasmeem Watson
- Fight Colorectal Cancer Research Advocate, Springfield, MO, United States of America
| | - Erin L Van Blarigan
- Department of Urology, University of California, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America.
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22
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Fortuna KL, Kadakia A, Cosco TD, Rotondi A, Nicholson J, Mois G, Myers AL, Hamilton J, Brewer LC, Collins-Pisano C, Barr P, Hudson MF, Joseph K, Mullaly C, Booth M, Lebby S, Walker R. Guidelines to Establish an Equitable Mobile Health Ecosystem. Psychiatr Serv 2022; 74:393-400. [PMID: 36377370 DOI: 10.1176/appi.ps.202200011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mobile health (mHealth)-that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care-is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeducation (i.e., information about mental health conditions), and delivering evidence-based practices. However, some groups may fail to benefit from mHealth despite a high need for mental health services, including people from racially and ethnically disadvantaged groups, rural residents, individuals who are socioeconomically disadvantaged, and people with disabilities. A well-designed mHealth ecosystem that considers multiple elements of design, development, and implementation can afford disadvantaged populations the opportunity to address inequities and facilitate access to and uptake of mHealth. This article proposes inclusion of the following principles and standards in the development of an mHealth ecosystem of equity: use a human-centered design, reduce bias in machine-learning analytical techniques, promote inclusivity via mHealth design features, facilitate informed decision making in technology selection, embrace adaptive technology, promote digital literacy through mHealth by teaching patients how to use the technology, and facilitate access to mHealth to improve health outcomes.
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Affiliation(s)
- Karen L Fortuna
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Arya Kadakia
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Theodore D Cosco
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Armando Rotondi
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Joanne Nicholson
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - George Mois
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Amanda L Myers
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Jennifer Hamilton
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - LaPrincess C Brewer
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Caroline Collins-Pisano
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Paul Barr
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Matthew F Hudson
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Kalisa Joseph
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Christa Mullaly
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Mark Booth
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Stephanie Lebby
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Robert Walker
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
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Yin Z, Liang Y, Howard JT, Errisuriz V, Estrada VM, Martinez C, Li S, Ullevig S, Sosa E, Olmstead T, Small S, Ward DS, Parra-Medina D. ¡Míranos! a Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: One-year Results of a Clustered Randomized Controlled Trial. Public Health Nutr 2022; 26:1-26. [PMID: 36357340 PMCID: PMC10172390 DOI: 10.1017/s1368980022002439] [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] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children. DESIGN A three-group clustered randomized controlled trial. SETTING Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home. STUDY OUTCOMES The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl). PARTICIPANTS Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29). RESULTS Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group. CONCLUSIONS There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.
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Affiliation(s)
- Zenong Yin
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Yuanyuan Liang
- The University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, USA
| | - Jeffrey T. Howard
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Vanessa Errisuriz
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
| | - Vanessa Marie Estrada
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Cristina Martinez
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Shiyu Li
- UT Health San Antonio, School of Nursing, San Antonio, Texas, USA
| | - Sarah Ullevig
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Erica Sosa
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Todd Olmstead
- The University of Texas at Austin, LBJ School of Public Affairs, Texas, USA
| | - Sharon Small
- Parent/Child Incorporated of San Antonio and Bexar County, San Antonio, Texas, USA
| | - Dianne Stanton Ward
- Department of Nutrition Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Deborah Parra-Medina
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
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24
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Fanning J, Brooks AK, Ford S, Robison JT, Irby MB, Rejeski WJ. A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial. Front Digit Health 2022; 4:1040867. [PMID: 36405417 PMCID: PMC9666366 DOI: 10.3389/fdgth.2022.1040867] [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: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
Chronic pain is a debilitating condition that affects many older adults who often have limited access to non-pharmacological pain management strategies. One potentially effective and novel lifestyle medicine for chronic pain involves increasing physical activity through frequent movement across the day, thereby also decreasing the presence of extended sedentary bouts. The MORPH-II pilot randomized controlled refinement trial iterated on the MORPH trial, which was a first-of-its-kind group-mediated daylong physical activity (DPA) intervention for older adults with chronic pain rooted in social cognitive and self-determination theories and supported by an mHealth toolset designed to foster social connection and awareness of physical activity patterns. MORPH-II was delivered fully remotely via videoconference software and supported by a technology kit comprising an iPad, activity monitor, and wireless weight scale. It was also implemented a refined coaching model designed to help participants better understand their own patterns of activity. A total of 44 participants were randomized to receive the 12-week group-mediated DPA intervention or to a low-contact control. Qualitative interviews suggest the program was well-received by participants and that participants developed an understanding of how patterns of physical activity related to their pain symptoms. Participants also highlighted several additional areas for refinement related to the coaching model and feedback provided within the mHealth app. Analyses of covariance, controlling for baseline values, revealed a small effect (η 2 = 0.01) on pain intensity favoring the intervention condition, though both groups improved during the study period. There was a large effect favoring the intervention condition on ActivPAL-assessed average daily steps (η 2 = 0.23) and postural shifts (η 2 = 0.24). Control participants spent less time in short sedentary bouts (η 2 = 0.09), and there was a small effect (η 2 = 0.02) indicating intervention participants spent less time in extended sedentary bouts. Finally, relative to control, intervention participants demonstrated a moderate improvement in autonomy satisfaction (η 2 = 0.05), relatedness frustration (η 2 = 0.05), and competence frustration (η 2 = 0.06), and a large magnitude improvement in competence satisfaction (η 2 = 0.22). These findings indicate that the MORPH-II intervention was feasible and acceptable, and may positively impact steps, postural breaks, and several key domains of basic psychological needs detailed in self-determination theory.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Justin T. Robison
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Megan B. Irby
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
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25
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Salloum RG, Wagner TH, Midboe AM, Daniels SI, Quanbeck A, Chambers DA. The economics of adaptations to evidence-based practices. Implement Sci Commun 2022; 3:100. [PMID: 36153575 PMCID: PMC9509646 DOI: 10.1186/s43058-022-00345-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based practices (EBPs) are frequently adapted in response to the dynamic contexts in which they are implemented. Adaptation is defined as the degree to which an EBP is altered to fit the setting or to improve fit to local context and can be planned or unplanned. Although adaptations are common and necessary to maximizing the marginal impact of EBPs, little attention has been given to the economic consequences and how adaptations affect marginal costs. Discussion In assessing the economic consequences of adaptation, one should consider its impact on core components, the planned adaptive periphery, and the unplanned adaptive periphery. Guided by implementation science frameworks, we examine how various economic evaluation approaches accommodate the influence of adaptations and discuss the pros and cons of these approaches. Using the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME), mixed methods can elucidate the economic reasons driving the adaptations. Micro-costing approaches are applied in research that integrates the adaptation of EBPs at the planning stage using innovative, adaptive study designs. In contrast, evaluation of unplanned adaptation is subject to confounding and requires sensitivity analysis to address unobservable measures and other uncertainties. A case study is presented using the RE-AIM framework to illustrate the costing of adaptations. In addition to empirical approaches to evaluating adaptation, simulation modeling approaches can be used to overcome limited follow-up in implementation studies. Conclusions As implementation science evolves to improve our understanding of the mechanisms and implications of adaptations, it is increasingly important to understand the economic implications of such adaptations, in addition to their impact on clinical effectiveness. Therefore, explicit consideration is warranted of how costs can be evaluated as outcomes of adaptations to the delivery of EBPs.
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26
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Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials 2022; 23:664. [PMID: 35978334 PMCID: PMC9383667 DOI: 10.1186/s13063-022-06568-3] [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: 04/01/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread agreement that the integration of cessation services in lung cancer screening (LCS) is essential for achieving the full benefits of LCS with low-dose computed tomography (LDCT). There is a formidable knowledge gap about how to best design feasible, effective, and scalable cessation services in LCS facilities. A collective of NCI-funded clinical trials addressing this gap is the Smoking Cessation at Lung Examination (SCALE) Collaboration. METHODS The Cessation and Screening to Save Lives (CASTL) trial seeks to advance knowledge about the reach, effectiveness, and implementation of tobacco treatment in lung cancer screening. We describe the rationale, design, evaluation plan, and interventions tested in this multiphase optimization strategy trial (MOST). A total of 1152 screening-eligible current smokers are being recruited from 18 LCS sites (n = 64/site) in both academic and community settings across the USA. Participants receive enhanced standard care (cessation advice and referral to the national Quitline) and are randomized to receive additional tobacco treatment components (motivational counseling, nicotine replacement patches/lozenges, message framing). The primary outcome is biochemically validated, abstinence at 6 months follow-up. Secondary outcomes are self-reported smoking abstinence, quit attempts, and smoking reduction at 3 and 6 months. Guided by the Implementation Outcomes Framework (IOF), our evaluation includes measurement of implementation processes (reach, fidelity, acceptability, appropriateness, sustainability, and cost). CONCLUSION We will identify effective treatment components for delivery by LCS sites. The findings will guide the assembly of an optimized smoking cessation package that achieves superior cessation outcomes. Future trials can examine the strategies for wider implementation of tobacco treatment in LDCT-LCS sites. TRIAL REGISTRATION ClinicalTrials.gov NCT03315910.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Donna R Shelley
- School of Global Public Health, New York University, New York, USA
| | - Lou-Anne Chichester
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, D.C., USA
| | | | | | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Irene Orlow
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Sharon V Chan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Victoria Frederico
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Phillip Camille
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Jessica Kenney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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27
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci 2022; 17:55. [PMID: 35964095 PMCID: PMC9375077 DOI: 10.1186/s13012-022-01226-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.
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Burris JL, Borger TN, Baker TB, Bernstein SL, Ostroff JS, Rigotti NA, Joseph AM. Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco. J Gen Intern Med 2022; 37:2548-2552. [PMID: 35474504 PMCID: PMC9360368 DOI: 10.1007/s11606-022-07553-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
There are evidence-based treatments for tobacco dependence, but inequities exist in the access to and reach of these treatments. Traditional models of tobacco treatment delivery are "reactive" and typically provide treatment only to patients who are highly motivated to quit and seek out tobacco treatment. Newer models involve "proactive" outreach, with benefits that include increasing access to tobacco treatment, prompting quit attempts among patients with low motivation, addressing health disparities, and improving population-level quit rates. However, the definition of "proactive" is not clear, and adoption has been slow. This commentary introduces a comprehensive yet flexible model of proactive outreach and describes how proactive outreach can optimize clinical research and care delivery in these domains: (1) identifying the population, (2) offering treatment, and (3) delivering treatment. Dimensions relevant to each domain are the intensity of proactive outreach (low to high) and the extent to which proactive outreach activities rely on human interaction or are facilitated by information technology (IT). Adoption of the proposed proactive outreach model could improve the precision and rigor with which tobacco cessation research and tobacco treatment programs report data, which could have a positive effect on care delivery and patient outcomes.
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Affiliation(s)
- Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, MB, Boston, USA
| | - Anne M Joseph
- Department of Medicine and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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Guerin R, Glasgow R, Tyler A, Rabin B, Huebschmann A. Methods to improve the translation of evidence-based interventions: A primer on dissemination and implementation science for occupational safety and health researchers and practitioners. SAFETY SCIENCE 2022; 152:105763. [PMID: 37854304 PMCID: PMC10583726 DOI: 10.1016/j.ssci.2022.105763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Objective A limited focus on dissemination and implementation (D&I) science has hindered the uptake of evidence-based interventions (EBIs) that reduce workplace morbidity and mortality. D&I science methods can be used in the occupational safety and health (OSH) field to advance the adoption, implementation, and sustainment of EBIs for complex workplaces. These approaches should be responsive to contextual factors, including the needs of partners and beneficiaries (such as employers, employees, and intermediaries). Methods By synthesizing seminal literature and texts and leveraging our collective knowledge as D&I science and/or OSH researchers, we developed a D&I science primer for OSH. First, we provide an overview of common D&I terminology and concepts. Second, we describe several key and evolving issues in D&I science: balancing adaptation with intervention fidelity and specifying implementation outcomes and strategies. Next, we review D&I theories, models, and frameworks and offer examples for applying these to OSH research. We also discuss widely used D&I research designs, methods, and measures. Finally, we discuss future directions for D&I science application to OSH and provide resources for further exploration. Results We compiled a D&I science primer for OSH appropriate for practitioners and evaluators, especially those newer to the field. Conclusion This article fills a gap in the OSH research by providing an overview of D&I science to enhance understanding of key concepts, issues, models, designs, methods and measures for the translation into practice of effective OSH interventions to advance the safety, health and well-being of workers.
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Affiliation(s)
- R.J. Guerin
- Division of Science Integration, National Institute for
Occupational Safety and Health, Centers for Disease Control and Prevention, 1090
Tusculum Ave., MS C-10, Cincinnati, OH 45226, USA
| | - R.E. Glasgow
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Department of Family Medicine,
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - A. Tyler
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Department of Pediatrics, Section
of Hospital Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - B.A. Rabin
- Herbert Wertheim School of Public Health and Human
Longevity Science, University of California San Diego, La Jolla, CA 92037, USA
- UC San Diego Altman Clinical and Translational Research
Institute Dissemination and Implementation Science Center, University of California
San Diego, La Jolla, CA 92037, USA
| | - A.G. Huebschmann
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Division of General Internal
Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Ludeman Family Center for
Women’s Health Research, Anschutz Medical Campus, Aurora, CO 80045, USA
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MacDonell KK, Wang B, Phanuphak N, Janamnuaysook R, Srimanus P, Rongkavilit C, Naar S. Optimizing an mHealth Intervention to Improve Uptake and Adherence to HIV Pre-exposure Prophylaxis in Young Transgender Women: Protocol for a Multi-Phase Trial. JMIR Res Protoc 2022; 11:e37659. [PMID: 35587370 PMCID: PMC9164094 DOI: 10.2196/37659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Vulnerable adolescents and emerging adults (aged 18-29 years), particularly young transgender women, are among the fastest-growing HIV positive populations worldwide. Thailand has the highest adult HIV seroprevalence in Asia, with a rate of infection among this population of 18%. Widespread technology offers opportunities for innovative mobile health (mHealth) interventions. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for at-risk individuals. PrEP is highly effective when taken as prescribed, but uptake and adherence have been low, with high discontinuation rates among youth. OBJECTIVE We propose to develop and pilot a multi-component, technology-based intervention to promote PrEP usage. We will adapt an existing 2-session, technology-delivered, motivational interviewing-based intervention to focus on PrEP use in transgender women in Thailand. We call this the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also refine and enhance YaCool, a mobile app with integrated text messaging developed and used clinically by our Thai team. The new version of the app is called Enhanced YaCool, and it enables self-management of gender and sexual health (including PrEP). Our primary aim is to develop and assess the preliminary efficacy of this mHealth intervention. METHODS We will utilize a multiphase optimization strategy (MOST) to identify the most effective intervention component or combination of components to improve PrEP usage in Thai transgender women. The study includes two phases: phase I (R21) includes qualitative interviews with key stakeholders to explore barriers and facilitators of PrEP usage through thematic analysis to inform intervention adaptation. Following this, we will adapt and beta-test MES-PrEP and Enhanced YaCool for functionality and feasibility using a community advisory board of HIV-negative Thai transgender women. In phase II (R33), we will conduct a MOST design-based trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and Enhanced YaCool. Eighty HIV-negative participants who are currently taking PrEP and 80 participants who are not will be randomized to four conditions: (1) standard PrEP counseling (the control condition); (2) MES-PrEP and standard PrEP counseling; (3) Enhanced YaCool and standard PrEP counseling; and (4) MES-PrEP, Enhanced YaCool, and standard PrEP counseling. Feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating the proportion of participants who initiate PrEP and their level of adherence to PrEP. Assessments will be at baseline and 1, 3, 6, 9, and 12 months postintervention. Biomarkers of adherence to PrEP, HIV, and other sexually transmitted infections will be collected. RESULTS Upon project completion, we will have an optimized mHealth intervention to support the use of PrEP by transgender women that will be ready for testing in a larger efficacy trial. CONCLUSIONS Even though transgender women in Thailand face increasing risks of HIV, few interventions have targeted them. Effective developmentally and culturally tailored interventions are needed to prevent HIV transmission in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT05262426; https://clinicaltrials.gov/ct2/show/NCT05262426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37659.
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Affiliation(s)
- Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | | | - Chokechai Rongkavilit
- Department of Pediatrics, University of California San Francisco-Fresno Branch Campus, Fresno, CA, United States
| | - Sylvie Naar
- Center for Translational Behavioral Research, Florida State University, Tallahassee, FL, United States
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Buss VH, Varnfield M, Harris M, Barr M. A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study. JMIR Hum Factors 2022; 9:e35065. [PMID: 35536603 PMCID: PMC9131155 DOI: 10.2196/35065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/26/2022] [Accepted: 03/26/2022] [Indexed: 01/16/2023] Open
Abstract
Background Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
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Affiliation(s)
- Vera Helen Buss
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Wyrick DL, Tanner AE, Milroy JJ, Guastaferro K, Bhandari S, Kugler KC, Thorpe S, Ware S, Miller AM, Collins LM. itMatters: Optimization of an online intervention to prevent sexually transmitted infections in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1212-1222. [PMID: 32692637 PMCID: PMC7909750 DOI: 10.1080/07448481.2020.1790571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
ObjectiveTo describe an iterative approach to developing an online intervention targeting the intersection of alcohol use and sexual behaviors among first year college students. Methods and Participants: Using the multiphase optimization strategy (MOST), we conducted two iterative optimization trials to: (1) identify candidate intervention components (i.e., descriptive norms, injunctive norms, outcome expectancies, perceived benefits of protective behavioral strategies, and self-efficacy to use strategies); (2) revise components; and (3) identify the optimized intervention. Participants were first year college students at six geographically diverse universities (optimization trial 1 N = 5,880; optimization trial 2 N = 3,551) Results: For both optimization trials, the results indicated that only descriptive and injunctive norms produced a significant effect (p<.05). Conclusions: The iterative process of MOST allowed us to develop an optimized intervention which is an essential tool to maximize intervention effectiveness and efficiency to improve uptake, sustainability, and public health impact.
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Affiliation(s)
- David L. Wyrick
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Amanda E. Tanner
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Jeffrey J. Milroy
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Kate Guastaferro
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
| | - Sandesh Bhandari
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
| | - Kari C. Kugler
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, Pennsylvania
| | - Shemeka Thorpe
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Samuella Ware
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Alicia M. Miller
- The University of North Carolina Greensboro, Department of Public Health Education, Greensboro, North Carolina
| | - Linda M. Collins
- The Pennsylvania State University, Methodology Center, University Park, Pennsylvania
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Glasser AM, Hinton A, Wermert A, Macisco J, Nemeth JM. Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness - considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors. BMC Public Health 2022; 22:820. [PMID: 35468777 PMCID: PMC9036780 DOI: 10.1186/s12889-022-13244-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention. METHODS This study included 96 youth (ages 14-24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana. RESULTS Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one's housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors. CONCLUSIONS Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Alice Hinton
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Joseph Macisco
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH 43210 USA
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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Phillips SM, Penedo FJ, Collins LM, Solk P, Siddique J, Song J, Cella D, Courneya KS, Ackermann RT, Welch WA, Auster-Gussman LA, Whitaker M, Cullather E, Izenman E, Spring B. Optimization of a technology-supported physical activity promotion intervention for breast cancer survivors: Results from Fit2Thrive. Cancer 2022; 128:1122-1132. [PMID: 34812521 PMCID: PMC8837679 DOI: 10.1002/cncr.34012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The benefits of moderate to vigorous physical activity (MVPA) for breast cancer survivors are well established. However, most are insufficiently active. Fit2Thrive used the Multiphase Optimization Strategy methodology to determine the effect of 5 intervention components on MVPA in this population. METHODS Two hundred sixty-nine participants (mean age, 52.5 years; SD, 9.9 years) received a core intervention (the Fit2Thrive self-monitoring app and Fitbit) and were randomly assigned to 5 intervention components set to on/off in a full factorial experiment: support calls, deluxe app, buddy, online gym, and text messages. The intervention was delivered over 12 weeks with a 12-week follow-up. MVPA was measured via accelerometry at the baseline (T1), at 12 weeks (T2), and at 24 weeks (T3). The main effects and interaction effects at each time point were examined for all components. RESULTS Trial retention was high: 91.8% had valid accelerometer data at T2 or T3. Across all conditions, there were significant increases in MVPA (+53.6 min/wk; P < .001) and in the proportion of survivors meeting MVPA guidelines (+22.3%; P < .001) at T2 that were maintained but attenuated at T3 (MVPA, +24.6 min/wk; P < .001; meeting guidelines, +12.6%; P < .001). No individual components significantly improved MVPA, although increases were greater for the on level versus the off level for support calls, buddy, and text messages at T2 and T3. CONCLUSIONS The Fit2Thrive core intervention (the self-monitoring app and Fitbit) is promising for increasing MVPA in breast cancer survivors, but the components provided no additional increases in MVPA. Future research should evaluate the core intervention in a randomized trial and determine what components optimize MVPA behaviors in breast cancer survivors.
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Affiliation(s)
| | | | | | - Payton Solk
- Northwestern University Feinberg School of Medicine
| | | | - Jing Song
- Northwestern University Feinberg School of Medicine
| | - David Cella
- Northwestern University Feinberg School of Medicine
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Shin S, Chakraborty B, Yan X, van Dam RM, Finkelstein EA. Evaluation of Combinations of Nudging, Pricing, and Labeling Strategies to Improve Diet Quality: A Virtual Grocery Store Experiment Employing a Multiphase Optimization Strategy. Ann Behav Med 2022; 56:933-945. [PMID: 35195704 DOI: 10.1093/abm/kaab115] [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: 11/14/2022] Open
Abstract
BACKGROUND Several intervention strategies have been shown to improve diet quality. However, there is limited evidence on the increase in effectiveness that may be achieved through select combinations of these strategies. PURPOSE This study aimed to identify an effective multicomponent intervention to improve diet quality of a grocery basket by applying a Multiphase Optimization Strategy framework and testing various combinations of four promising strategies using a fully functional web-based grocery store: (i) front-of-pack food labels and real-time feedback of the healthiness of the shoppers' grocery basket, (ii) a tax, (iii) ordering products by a nutritional quality score, and (iv) healthier substitute offers. METHODS We conducted a hypothetical shopping study (N = 756) with a randomized full factorial design (16 conditions) to estimate main and interaction effects of the four interventions. RESULTS The "food labels & real-time feedback" and "ordering" strategies had significantly positive main effects on overall diet quality of the shopping basket (both at p < .001). We found no effects on diet quality for the "tax" and "healthier substitute offers." None of the two-way interaction effects for different strategies on overall diet quality and nutrients were significant. CONCLUSIONS Having "food labels & real-time feedback" and "ordering" simultaneously seemed to be more effective at improving diet quality, compared to having only one of these interventions. These results suggest that a combination of food labels with real-time feedback and ordering interventions can be part of a promising multicomponent strategy to improve diet quality in online shopping platforms. TRIAL REGISTRATION ClinicalTrials.gov NCT04632212.
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Affiliation(s)
- Soye Shin
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Bibhas Chakraborty
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.,Department of Statistics and Applied Probability, National University of Singapore, Singapore.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Xiaoxi Yan
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eric A Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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37
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Adams MA, Todd M, Angadi SS, Hurley JC, Stecher C, Berardi V, Phillips CB, McEntee ML, Hovell MF, Hooker SP. Adaptive Goals and Reinforcement Timing to Increase Physical Activity in Adults: A Factorial Randomized Trial. Am J Prev Med 2022; 62:e57-e68. [PMID: 35000693 PMCID: PMC8820277 DOI: 10.1016/j.amepre.2021.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Potent lifestyle interventions to increase moderate-to-vigorous physical activity are urgently needed for population-level chronic disease prevention. This trial tested the independent and joint effects of a mobile health system automating adaptive goal setting and immediate financial reinforcement for increasing daily walking among insufficiently active adults. STUDY DESIGN Participants were randomized into a 2 (adaptive versus static goal setting) X 2 (immediate versus delayed financial incentive timing) condition factorial trial to increase walking. SETTINGS/PARTICIPANTS Participants (N=512 adults) were recruited between 2016 and 2018 and were 64.5% female, aged 18-60 years, 18.8% Hispanic, 6.1% African American, and 83% White. INTERVENTION Principles of reinforcement and behavioral economics directed intervention design. MAIN OUTCOME MEASURES Participants wore accelerometers daily (133,876 day-level observations) that remotely measured moderate-to-vigorous physical activity bout minutes of ≥3 minutes/day for 1 year. Primary outcomes were between-condition differences in (1) engaging ≥1 bout of moderate-to-vigorous physical activity on each day and (2) on days with ≥1 bout, daily total moderate-to-vigorous physical activity minutes. RESULTS Mixed-effects hurdle models tested treatment group X phase (time) interactions using an intent-to-treat approach in 2021. Engaging in any ambulatory moderate-to-vigorous physical activity was greater for Adaptive than for Static Goal groups (OR=2.34, 95% CI=2.10, 2.60 vs OR=1.66, 95% CI=1.50, 1.84; p<0.001) and for Immediate than for Static Reinforcement groups (OR=2.16 95% CI=1.94, 2.40 vs OR=1.77, 95% CI=1.59, 1.97; p<0.01). The Immediate Reinforcement group increased by 16.54 moderate-to-vigorous physical activity minutes/day, whereas the Delayed Reinforcement group increased by 9.91 minutes/day (p<0.001). The combined Adaptive Goals + Immediate Reinforcement group increased by 16.52 moderate-to-vigorous physical activity minutes/day, significantly more than that of either Delayed Reinforcement group. CONCLUSIONS This study offers automated and scalable-behavior change strategies for increasing walking among adults most at-risk for chronic diseases attributed to sedentary lifestyles. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02717663).
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Affiliation(s)
- Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Siddhartha S Angadi
- College of Health Solutions, Arizona State University, Phoenix, Arizona; Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, Virginia
| | - Jane C Hurley
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Vincent Berardi
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, California
| | | | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Melbourne F Hovell
- School of Public Health, San Diego State University, San Diego, California
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California
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Basen-Engquist K, Raber M, Strong LL, Schembre S, Li L, Arun B, Lu K, You N, Vilar E, Lynch P, Fares S, Peterson SK. Optimization of an mHealth lifestyle intervention for families with hereditary cancer syndromes: Study protocol for a multiphase optimization strategy feasibility study. Contemp Clin Trials 2021; 113:106662. [PMID: 34971795 DOI: 10.1016/j.cct.2021.106662] [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: 07/23/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Individuals at increased hereditary risk of cancer are an important target for health promotion and cancer prevention interventions. Health-4-Families uses the Multiphase Optimization STrategy (MOST) framework and is designed to pilot digital delivery strategies for a distance-based, 16-week intervention to promote weight management, healthy diet, and increased physical activity among individuals with BRCA1/BRCA2 or DNA mismatch repair (MMR) pathogenic germline variants. This communication describes participant recruitment and the design of the Health-4-Families pilot study. METHODS Health-4-Families is a full-factorial (16 condition) randomized pilot study of four lifestyle intervention components: social networking, telephone or email coaching, text messaging, and self-monitoring. The primary outcome was feasibility and satisfaction with these study components. Participants with pathogenic germline variants were identified via clinic surveillance lists and advocacy organizations and were invited to participate with family members. All participants had to report meeting at least one of the following criteria: (1) having a BMI ≥ 25 kg/m2, (2) consuming <5 servings of fruit and vegetables per day, or (3) getting <150 min of moderate-to-vigorous intensity activity per week. RESULTS The majority of screened potential participants with pathogenic variants (83%) were eligible; 86% of those eligible provided informed consent and 79% (n = 104) completed baseline. A total of 206 family members were nominated by study participants and 49% (n = 102) completed baseline. DISCUSSION Recruitment data suggest that individuals with pathogenic germline variants, who are at increased risk for hereditary cancers, are motivated to participate in digital lifestyle interventions. This recruitment success highlights the importance of identifying and prioritizing effective and efficient intervention components for hereditary cancer families. We intend to use the outcomes of our pilot study to inform a fully-powered factorial study for this community.
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Affiliation(s)
- Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Margaret Raber
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Larkin L Strong
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, TX, United States of America
| | - Susan Schembre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Family and Community Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, United States of America
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Karen Lu
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Eduardo Vilar
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Patrick Lynch
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Sara Fares
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Feinstein JA, Berry JG, Feudtner C. Intervention research to improve care and outcomes for children with medical complexity and their families. Curr Probl Pediatr Adolesc Health Care 2021; 51:101126. [PMID: 34996708 PMCID: PMC8825706 DOI: 10.1016/j.cppeds.2021.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Healthcare and outcomes for children with medical complexity (CMC) and their families can be improved by conducting well-conceived, designed, implemented, and analyzed research studies of clinical interventions. This article presents a framework for how to approach the study of clinical interventions for CMC, including 7 key questions and example answers to each: (1) What intervention questions should be our focus? (2) What barriers to intervention research exist? (3) How do we design and optimize interventions? (4) How do we characterize and select patients to enroll? (5) How can we enhance data collection and integration? (6) How can we improve enrollment and participation? And (7) which intervention experimental designs should we choose? By exploring each of these key aspects of intervention-based research, we hope to expand thinking about and spark ideas for specific research projects focused on clinical interventions for CMC.
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Affiliation(s)
- James A Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado, Aurora, CO, United States.
| | - Jay G Berry
- Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, United States
| | - Chris Feudtner
- Division of General Pediatrics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Landoll RR, Vargas SE, Samardzic KB, Clark MF, Guastaferro K. The preparation phase in the multiphase optimization strategy (MOST): a systematic review and introduction of a reporting checklist. Transl Behav Med 2021; 12:291-303. [PMID: 34850214 DOI: 10.1093/tbm/ibab146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multicomponent behavioral interventions developed using the multiphase optimization strategy (MOST) framework offer important advantages over alternative intervention development models by focusing on outcomes within constraints relevant for effective dissemination. MOST consists of three phases: preparation, optimization, and evaluation. The preparation phase is critical to establishing the foundation for the optimization and evaluation phases; thus, detailed reporting is critical to enhancing rigor and reproducibility. A systematic review of published research using the MOST framework was conducted. A structured framework was used to describe and summarize the use of MOST terminology (i.e., preparation phase and optimization objective) and the presentation of preparation work, the conceptual model, and the optimization. Fifty-eight articles were reviewed and the majority focused on either describing the methodology or presenting results of an optimization trial (n = 38, 66%). Although almost all articles identified intervention components (96%), there was considerable variability in the degree to which authors fully described other elements of MOST. In particular, there was less consistency in use of MOST terminology. Reporting on the MOST preparation phase is varied, and there is a need for increased focus on explicit articulation of key design elements and rationale of the preparation phase. The proposed checklist for reporting MOST studies would significantly advance the use of this emerging methodology and improve implementation and dissemination of MOST. Accurate reporting is essential to reproducibility and rigor of scientific trials as it ensures future research fully understands not only the methodology, but the rationale for intervention and optimization decisions.
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Affiliation(s)
- Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Sara E Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kristen B Samardzic
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Madison F Clark
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kate Guastaferro
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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Baker TB, Bolt DM, Smith SS. Barriers to Building More Effective Treatments: Negative Interactions Amongst Smoking Intervention Components. Clin Psychol Sci 2021; 9:995-1020. [PMID: 35003904 PMCID: PMC8740936 DOI: 10.1177/2167702621994551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Meaningfully improved mental and behavioral health treatment is an unrealized dream. Across three factorial experiments, inferential tests in prior studies showed a pattern of negative interactions suggesting that better clinical outcomes are obtained when participants receive fewer rather than more intervention components. Further, relatively few significant main effects were found in these experiments. Modeling suggested that negative interactions amongst components may account for these patterns. This paper evaluates factors that may contribute to such declining benefit: increased attentional or effort burden; components that produce their effects via the same capacity limited mechanisms, making their effects subadditive; and a tipping point phenomenon in which those near a hypothesized "tipping point" for change will benefit markedly from weak intervention while those far from the tipping point will benefit little from even strong intervention. New research should explore factors that cause negative interactions amongst components and constrain the development of more effective treatments.
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Affiliation(s)
- Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin, Department of Educational Psychology, 1025 W. Johnson St., Madison, WI 53706
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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Cook JW, Baker TB, Fiore MC, Collins LM, Piper ME, Schlam TR, Bolt DM, Smith SS, Zwaga D, Jorenby DE, Mermelstein R. Evaluating four motivation-phase intervention components for use with primary care patients unwilling to quit smoking: a randomized factorial experiment. Addiction 2021; 116:3167-3179. [PMID: 33908665 PMCID: PMC8492501 DOI: 10.1111/add.15528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
AIMS To assess the effectiveness of intervention components designed to increase quit attempts and promote abstinence in patients initially unwilling to quit smoking. DESIGN A four-factor, randomized factorial experiment. SETTING Sixteen primary care clinics in southern Wisconsin. PARTICIPANTS A total of 577 adults who smoke (60% women, 80% White) recruited during primary care visits who were currently willing to reduce their smoking but unwilling to try to quit. Interventions Four factors contrasted intervention components administered over a 1-year period: (i) nicotine mini-lozenge versus none; (ii) reduction counseling versus none; (iii) behavioral activation (BA) counseling versus none; and (iv) motivational 5Rs counseling versus none. Participants could request cessation treatment at any time. MEASUREMENTS The primary outcome was 7-day point-prevalence abstinence at 52 weeks post enrollment; secondary outcomes were point-prevalence abstinence at 26 weeks and making a quit attempt by weeks 26 and 52. FINDINGS No abstinence main effects were found but a mini-lozenge × reduction counseling × BA interaction was found at 52 weeks; P = 0.03. Unpacking this interaction showed that the mini-lozenge alone produced the highest abstinence rate (16.7%); combining it with reduction counseling produced an especially low abstinence rate (4.1%). Reduction counseling decreased the likelihood of making a quit attempt by 52 weeks relative to no reduction counseling (P = 0.01). CONCLUSIONS Nicotine mini-lozenges may increase smoking abstinence in people initially unwilling to quit smoking, but their effectiveness declines when used with smoking reduction counseling or other behavioral interventions. Reduction counseling decreases the likelihood of making a quit attempt in people initially unwilling to quit smoking.
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Affiliation(s)
- Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Goodman W, Allsop M, Downing A, Munro J, Taylor C, Hubbard G, Beeken RJ. A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma. J Adv Nurs 2021; 78:722-738. [PMID: 34708416 DOI: 10.1111/jan.15085] [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] [Received: 05/24/2021] [Revised: 08/20/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
Abstract
AIMS Explore the evidence from randomized controlled trials for the effect of self-management interventions on quality of life, self-management skills and self-efficacy, and to explore which intervention characteristics are associated with effectiveness. DESIGN Systematic review. DATA SOURCES A search of the literature was conducted in these databases: MEDLINE (OVID), EMBASE (OVID) and PsychINFO (OVID) from January 2000 to February 2020. REVIEW METHODS Studies were included if participants had a bowel stoma, were over the age of 18 and the design was a randomized controlled trial of a self-management programme. The outcome measures for this review were quality of life, self-management skills and self-efficacy. The Behaviour Change Technique Taxonomy was used to code interventions for underlying components and alongside other intervention characteristics, associations with improvements in outcomes were explored. RESULTS The search identified 3141 articles, 16 of which were eligible. A meta-analysis of self-efficacy scores from five studies (N = 536) found an improvement in those that received the self-management intervention at follow-up with a 12-point mean difference compared with the usual care group. Effects on quality of life and self-management skills were mixed, and meta-analyses of these data were not possible. Across 13 studies an average of 10 behaviour change techniques were used with, credible source (e.g. nurse, doctor, therapist) (n = 13), instruction on how to perform the behaviour (n = 13), demonstration of the behaviour (n = 12) used most often. The behaviour change technique of self-monitoring was associated with an improvement in quality of life. The involvement of a nurse was associated with higher self-efficacy and self-management skills. CONCLUSION This review suggests that self-management interventions can increase peoples' self-efficacy for managing their stoma. IMPACT A standardized approach to the reporting of interventions and the measures used is needed in future studies to better understand the effect on quality of life and self-management skills.
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Affiliation(s)
| | | | - Amy Downing
- School of Medicine, University of Leeds, Leeds, UK
| | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | | | - Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Rebecca J Beeken
- School of Medicine, University of Leeds, Leeds, UK.,Research Department of Behavioural Science and Health, University College London, London, UK
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Perry HB, Chowdhury M, Were M, LeBan K, Crigler L, Lewin S, Musoke D, Kok M, Scott K, Ballard M, Hodgins S. Community health workers at the dawn of a new era: 11. CHWs leading the way to "Health for All". Health Res Policy Syst 2021; 19:111. [PMID: 34641891 PMCID: PMC8506098 DOI: 10.1186/s12961-021-00755-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This is the concluding paper of our 11-paper supplement, "Community health workers at the dawn of a new era". METHODS We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes. RESULTS CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness. CONCLUSION A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.
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Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway and Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maryse Kok
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Independent Consultant, Toronto, Canada
| | - Madeleine Ballard
- Community Health Impact Coalition, New York, NY, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Steve Hodgins
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Howard MC. A more comprehensive measure of vaccine hesitancy: Creation of the Multidimensional Vaccine Hesitancy Scale (MVHS). J Health Psychol 2021; 27:2402-2419. [PMID: 34474616 DOI: 10.1177/13591053211042062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article aimed to develop the Multidimensional Vaccine Hesitancy Scale (MVHS). In Study 1 (n = 336), we identified 13 possible vaccine hesitancy dimensions and developed an item list. In Study 2 (n = 444), we performed an exploratory factor analysis that supported an eight-dimension structure and reduced our measure to 32 items. We supported its validity by establishing relations with associated variables, even while controlling for measures of the same and similar constructs. In Study 3 (n = 575), we confirmed its factor structure and replicated its validity results. Support was provided for the psychometric properties and validity of the MVHS.
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Sucala M, Ezeanochie NP, Cole-Lewis H, Turgiss J. An iterative, interdisciplinary, collaborative framework for developing and evaluating digital behavior change interventions. Transl Behav Med 2021; 10:1538-1548. [PMID: 31328775 PMCID: PMC7796712 DOI: 10.1093/tbm/ibz109] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The rapid expansion of technology promises to transform the behavior science field by revolutionizing the ways in which individuals can monitor and improve their health behaviors. To fully live into this promise, the behavior science field must address distinct challenges, including: building interventions that are not only scientifically sound but also engaging; using evaluation methods to precisely assess intervention components for intervention optimization; and building personalized interventions that acknowledge and adapt to the dynamic ecosystem of individual and contextual variables that impact behavior change. The purpose of this paper is to provide a framework to address these challenges by leveraging behavior science, human-centered design, and data science expertise throughout the cycle of developing and evaluating digital behavior change interventions (DBCIs). To define this framework, we reviewed current models and practices for intervention development and evaluation, as well as technology industry models for product development. The framework promotes an iterative process, aiming to maximize outcomes by incorporating faster and more frequent testing cycles into the lifecycle of a DBCI. Within the framework provided, we describe each phase, from development to evaluation, to discuss the optimal practices, necessary stakeholders, and proposed evaluation methods. The proposed framework may inform practices in both academia and industry, as well as highlight the need to offer collaborative platforms to ensure successful partnerships that can lead to more effective DBCIs that reach broad and diverse populations.
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Affiliation(s)
- Madalina Sucala
- Johnson and Johnson Health and Wellness Solutions Inc., New Brunswick, NJ, USA
| | | | - Heather Cole-Lewis
- Johnson and Johnson Health and Wellness Solutions Inc., New Brunswick, NJ, USA
| | - Jennifer Turgiss
- Johnson and Johnson Health and Wellness Solutions Inc., New Brunswick, NJ, USA
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Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis. Cancer Causes Control 2021; 32:1333-1345. [PMID: 34313875 DOI: 10.1007/s10552-021-01481-7] [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] [Received: 12/21/2020] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. METHODS iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. RESULTS Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. CONCLUSION NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.
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Fanning J, Brooks AK, Hsieh KL, Kershner K, Furlipa J, Nicklas BJ, Rejeski WJ. Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial. JMIR Res Protoc 2021; 10:e29013. [PMID: 34279241 PMCID: PMC8329761 DOI: 10.2196/29013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults' chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program's scalability and potential efficacy. OBJECTIVE The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. METHODS The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory-based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. RESULTS Recruitment is ongoing as of January 2021. CONCLUSIONS Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/29013.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Amber K Brooks
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - Kyle Kershner
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Joy Furlipa
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | | | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, Gunnell D, Anwer S, López-López JA, French C, Kidger J, Dawson S, Churchill R, Thomas J, Campbell R, Welton NJ. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Sumayya Anwer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), University College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
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50
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Wells RD, Guastaferro K, Azuero A, Rini C, Hendricks BA, Dosse C, Taylor R, Williams GR, Engler S, Smith C, Sudore R, Rosenberg AR, Bakitas MA, Dionne-Odom JN. Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care. J Pain Symptom Manage 2021; 62:174-182. [PMID: 33253787 PMCID: PMC8274323 DOI: 10.1016/j.jpainsymman.2020.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
Recent systematic reviews and meta-analyses have reported positive benefit of multicomponent "bundled" palliative care interventions for patients and family caregivers while highlighting limitations in determining key elements and mechanisms of improvement. Traditional research approaches, such as the randomized controlled trial (RCT), typically treat interventions as "bundled" treatment packages, making it difficult to assess definitively which aspects of an intervention can be reduced or replaced or whether there are synergistic or antagonistic interactions between intervention components. Progressing toward palliative care interventions that are effective, efficient, and scalable will require new strategies and novel approaches. One such approach is the Multiphase Optimization Strategy (MOST), a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. This article provides a brief overview and application of MOST and factorial trial design in palliative care research, including our insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).
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Affiliation(s)
- Rachel D Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Kate Guastaferro
- Methodology Center, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Bailey A Hendricks
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chinara Dosse
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sally Engler
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charis Smith
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebecca Sudore
- School of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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