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McCarthy MM, Del Giudice I, Wong A, Fletcher J, Dickson VV, D'Eramo Melkus G. Cardiovascular Health in Black and Latino Adults With Type 2 Diabetes. Nurs Res 2024; 73:270-277. [PMID: 38498851 PMCID: PMC11192611 DOI: 10.1097/nnr.0000000000000730] [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: 03/20/2024]
Abstract
BACKGROUND The incidence of type 2 diabetes (T2DM) among U.S. adults has been rising annually, with a higher incidence rate in Black and Hispanic adults than in Whites. The American Heart Association (AHA) has defined cardiovascular health according to the achievement of seven health behaviors (smoking, body mass index [BMI], physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose). Optimal cardiovascular health has been associated with a lower risk of cardiovascular disease, and awareness of this risk may influence healthy behaviors. OBJECTIVES This study aimed to assess cardiovascular health in a sample of Black and Hispanic adults (age: 18-40 years) with T2DM and explore the barriers and facilitators to diabetes self-management and cardiovascular health. METHODS This was an explanatory sequential mixed-method design. The study staff recruited adults with T2DM for the quantitative data followed by qualitative interviews with a subsample of participants using maximum variation sampling. The seven indices of cardiovascular health as defined by the AHA's "Life's Simple 7" were assessed: health behaviors (smoking, BMI, physical activity, diet) and health factors (total cholesterol, blood pressure, A1C). Qualitative interviews were conducted to explore their results as well as the effects of the pandemic on diabetes self-management. Qualitative and quantitative data were integrated into the final analysis phase. RESULTS The majority of the sample was female, with 63% identifying as Black and 47% as Hispanic. The factor with the lowest achievement of ideal levels was BMI, followed by a healthy diet. Less than half achieved ideal levels of blood pressure or physical activity. Themes that emerged from the qualitative data included the impact of social support, the effects of the pandemic on their lives, and educating themselves about T2DM. DISCUSSION Achievement of ideal cardiovascular health factors varied, but the achievement of several health factors may be interrelated. Intervening on even one factor while providing social support may improve other areas of cardiovascular health in this population.
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Condinho M, Ramalhinho I, Vaz-Velho C, Sinogas C. Mental Health Evaluation in Community Pharmacies-A Cross-Sectional Study. PHARMACY 2024; 12:89. [PMID: 38921965 PMCID: PMC11207391 DOI: 10.3390/pharmacy12030089] [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: 04/30/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Portugal has a high prevalence of anxiety and depression, and community pharmacists are well-placed to identify mental health problems and monitor their treatment. This study aimed to screen undiagnosed people for symptoms of anxiety and depression and to monitor these conditions in diagnosed patients. We conducted an observational, cross-sectional study of a sample of community pharmacy users. Anxiety and depression symptoms were assessed using the Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Altogether, 591 participants were enrolled between September 2020 and July 2021, 74.9% of whom were female. Of the 477 undiagnosed participants who completed the GAD-7, 87 (18.2%) had moderate or severe anxiety symptoms. Of the 485 participants who completed the PHQ-9, 59 (12.1%) had moderate or severe symptoms of depression. Of the 94 patients diagnosed with anxiety, 37 (39.4%) reported moderate to severe symptoms. Similarly, of the 97 patients with depression, almost half (49.5%) reported moderate to severe symptoms. Anxiety levels were lower among men and among those who reported not taking any medication (p < 0.001). Moderate or severe symptoms of depression were more common among women (p < 0.001), participants with lower education levels (p < 0.005), participants who live alone (p < 0.007), and those taking medication for insomnia (p < 0.001), pain (p < 0.001), anxiety (p < 0.001), and/or depression (p < 0.001). Screening for anxiety and depression revealed that a significant proportion of undiagnosed participants had clinically relevant symptoms of anxiety and depression. However, among participants diagnosed with anxiety and depression, between 40% and 50% were uncontrolled, respectively. These data highlight pharmacists' role in identifying customers at risk of anxiety and depression as well as the need for better monitoring of those already diagnosed.
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Affiliation(s)
- Mónica Condinho
- AcF—Acompanhamento Farmacoterapêutico, Lda., 7490-324 Pavia, Portugal;
- Faculty of Sciences and Technology, University of Algarve, 8005-139 Faro, Portugal;
- ABC-RI, Algarve Biomedical Center Research Institute, 8005-139 Faro, Portugal
| | - Isabel Ramalhinho
- Faculty of Sciences and Technology, University of Algarve, 8005-139 Faro, Portugal;
- ABC-RI, Algarve Biomedical Center Research Institute, 8005-139 Faro, Portugal
| | - Catarina Vaz-Velho
- Department of Psychology, University of Évora, 7004-516 Évora, Portugal;
| | - Carlos Sinogas
- AcF—Acompanhamento Farmacoterapêutico, Lda., 7490-324 Pavia, Portugal;
- Department of Medical and Health Sciences, University of Évora, 7004-516 Évora, Portugal
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Wen Y, Han X, Sun M, Wang L, Zhu X, Wang X, Wang C. The anxiety and depression status and related influencing factors in patients with type 2 diabetes: Why should we care. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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McGrath N, McHugh S, Kearney PM, Toomey E. Barriers and enablers to screening and diagnosing depression and diabetes distress in people with type 2 diabetes mellitus; protocol of a qualitative evidence synthesis. HRB Open Res 2020; 2:26. [PMID: 33083689 PMCID: PMC7539074 DOI: 10.12688/hrbopenres.12947.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Depression and diabetes distress are common in people with type 2 diabetes (T2DM). These conditions are independently associated with poorer T2DM outcomes and increased healthcare utilisation and costs. Questions remain regarding the most appropriate ways of initially detecting depression and diabetes distress in this group. Diabetes guidelines recommend depression screening in primary care for people with T2DM but their implementation in practice is suboptimal. As health care professionals influence detection practices, their perceptions and experiences of these guidelines can improve understanding of aspects of the guidelines that work, and those which are more difficult to implement in practice. This study describes the protocol for a qualitative evidence synthesis of primary care health professionals’ perceived barriers and enablers to screen for and diagnose depression and diabetes distress in people with T2DM. Methods and analysis: Primary qualitative studies will be identified using a systematic search of electronic databases and supplementary searching. We selected ‘best-fit framework synthesis’ as the approach to synthesise primary data using the RETREAT (Review question-Epistemology-Time/Timescale-Resources-Expertise-Audience and purpose-Type of Data) framework. Quality appraisal of primary studies and confidence in the overall review findings will be determined using the CASP (Critical Appraisal Skills Programme) and the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative research), respectively. Discussion: The planned review will provide the first, single point of reference of the available synthesised qualitative evidence on this topic. It will apply recommended approaches to ensure rigor and robustness of study and contribute meaningfully to understanding of how depression and diabetes distress can be initially detected in people with T2DM. This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) [registration number: CRD42019145483].
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Affiliation(s)
- Niamh McGrath
- School of Public health, University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public health, University College Cork, Cork, Ireland
| | | | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Galway, Ireland.,School of Allied Health, University of Limerick, Limerick, Ireland
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McGrath N, McHugh S, Kearney PM, Toomey E. Barriers and enablers to screening and diagnosing depression and diabetes distress in people with type 2 diabetes mellitus; protocol of a qualitative evidence synthesis. HRB Open Res 2020; 2:26. [PMID: 33083689 PMCID: PMC7539074 DOI: 10.12688/hrbopenres.12947.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 10/13/2023] Open
Abstract
Background: Depression and diabetes distress are common in people with type 2 diabetes (T2DM). These conditions are independently associated with poorer T2DM outcomes and increased healthcare utilisation and costs. Questions remain regarding the most appropriate ways of initially detecting depression and diabetes distress in this group. Diabetes guidelines recommend depression screening in primary care for people with T2DM but their implementation in practice is suboptimal. As health care professionals influence detection practices, their perceptions and experiences of these guidelines can improve understanding of aspects of the guidelines that work, and those which are more difficult to implement in practice. This study describes the protocol for a qualitative evidence synthesis of primary care health professionals' perceived barriers and enablers to screen for and diagnose depression and diabetes distress in people with T2DM. Methods and analysis: Primary qualitative studies will be identified using a systematic search of electronic databases and supplementary searching. We selected 'best-fit framework synthesis' as the approach to synthesise primary data using the RETREAT (Review question-Epistemology-Time/Timescale-Resources-Expertise-Audience and purpose-Type of Data) framework. Quality appraisal of primary studies and confidence in the overall review findings will be determined using the CASP (Critical Appraisal Skills Programme) and the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative research), respectively. Discussion: The planned review will provide the first, single point of reference of the available synthesised qualitative evidence on this topic. It will apply recommended approaches to ensure rigor and robustness of study and contribute meaningfully to understanding of how depression and diabetes distress can be initially detected in people with T2DM. This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) [registration number: CRD42019145483].
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Affiliation(s)
- Niamh McGrath
- School of Public health, University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public health, University College Cork, Cork, Ireland
| | | | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
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Abstract
OBJECTIVE Anxiety disorders are among the most frequent mental disorders and are associated with a range of short- and long-term impairments and disabilities. Relatively little is known about anxiety disorders in patients with somatic diseases, and the present literature review highlights the current research in this field, data about prevalences of anxiety disorders in patients with somatic diseases, and the effectiveness of interventions. This article also introduces a comprehensive model of inpatient treatment and summarizes the evidence pertinent to this approach. METHODS A narrative review is presented with regard to prevalence and treatment of anxiety disorders in patients with somatic diseases. The effects of inpatient treatment are illustrated based on a case report. RESULTS This review indicates that anxiety disorders are more common in patients with somatic diseases, with prevalence estimates ranging from 2.5% to 55%, than in the general population. Several outpatient treatment options exist, with substantial support for the effectiveness of cognitive behavioral therapy, psychodynamic therapy, and pharmacotherapy. We also provide evidence in support of psychosomatic inpatient treatment for patients with anxiety disorders that are comorbid with somatic diseases. CONCLUSIONS Anxiety disorders are common in patients with somatic diseases, and several effective treatment options exist, including cognitive behavioral therapy and pharmacological interventions. We also provide support for the effectiveness of inpatient treatment with unique opportunities for multidisciplinary psychosomatic treatment of anxiety disorders with comorbid somatic diseases.
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Affiliation(s)
- Michaela Henning
- From the Department of Psychosomatic Medicine and Psychotherapy (Henning, Subic-Wrana, Wiltink, Beutel), University Medical Center, Mainz; and Department of Psychosomatics and Psychotherapy (Henning), University Hospital Cologne, University of Cologne, Cologne, Germany
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McGrath N, McHugh S, Kearney PM, Toomey E. Barriers and enablers to screening and diagnosing depression and diabetes distress in people with type 2 diabetes mellitus; protocol of a qualitative evidence synthesis. HRB Open Res 2020; 2:26. [DOI: 10.12688/hrbopenres.12947.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Depression and diabetes distress are common in people with type 2 diabetes (T2DM). These conditions are independently associated with poorer T2DM outcomes and increased healthcare utilisation and costs. Questions remain regarding the most appropriate ways of initially detecting depression and diabetes distress in this group. Diabetes guidelines recommend depression screening in primary care for people with T2DM but their implementation in practice is suboptimal. As health care professionals influence detection practices, their perceptions and experiences of these guidelines can improve understanding of aspects of the guidelines that work, and those which are more difficult to implement in practice. This study describes the protocol for a qualitative evidence synthesis of primary care health professionals’ perceived barriers and enablers to screen for and diagnose depression and diabetes distress in people with T2DM. Methods and analysis: Primary qualitative studies will be identified using a systematic search of electronic databases and supplementary searching. We selected ‘best-fit framework synthesis’ as the approach to synthesise primary data using the RETREAT (Review question-Epistemology-Time/Timescale-Resources-Expertise-Audience and purpose-Type of Data) framework. Quality appraisal of primary studies and confidence in the overall review findings will be determined using the CASP (Critical Appraisal Skills Programme) and the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative research), respectively. Discussion: The planned review will provide the first, single point of reference of the available synthesised qualitative evidence on this topic. It will apply recommended approaches to ensure rigor and robustness of study and contribute meaningfully to understanding of how depression and diabetes distress can be initially detected in people with T2DM. This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) [registration number: CRD42019145483].
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Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, Kyrios M, Speight J, Pouwer F. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. J Diabetes Complications 2019; 33:523-529. [PMID: 31129003 DOI: 10.1016/j.jdiacomp.2019.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type. METHODS Cross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10. RESULTS In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone. CONCLUSIONS Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.
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Affiliation(s)
- Giesje Nefs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg, the Netherlands; Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, the Netherlands.
| | - Christel Hendrieckx
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Prasuna Reddy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; University of Technology Sydney, Australia; Swinburne University of Technology, Hawthorn, Australia
| | | | - Mariska Bot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - John Dixon
- Human Neurotransmitters, Baker Heart and Diabetes Institute, Melbourne, Australia; Primary Care Research, Monash University, Melbourne, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Australia
| | - Jane Speight
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia; AHP Research, Hornchurch, United Kingdom; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - François Pouwer
- Deakin University, School of Psychology, Geelong, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Center Odense
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van der Donk LJ, Fleer J, Sanderman R, Emmelkamp PMG, Links TP, Tovote KA, Schroevers MJ. Is type of depressive symptoms associated with patient-perceived need for professional psychological care in depressed individuals with diabetes? PLoS One 2019; 14:e0212304. [PMID: 30763396 PMCID: PMC6375619 DOI: 10.1371/journal.pone.0212304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/31/2019] [Indexed: 12/03/2022] Open
Abstract
Aims The objective of this study is to investigate whether type of depressive symptoms (i.e. cognitive-affective or somatic) is related to a patient-perceived need for professional psychological care in individuals with diabetes. Methods In total 2266 participants were recruited as part of the screening procedure for a multi-center randomized controlled trial on the treatment of depressive symptoms among individuals with diabetes. Individuals were invited to complete Beck Depression Inventory-II (BDI-II). Patients with elevated depressive symptoms (BDI-II ≥14) were interviewed about their psychological care need. Based on their care needs patients were categorized into: unmet need, no need, met need and unclear need. These groups were compared on type of depressive symptoms, as categorized into cognitive-affective symptoms and somatic symptoms. Results 568 eligible individuals had elevated depressive symptoms, of whom 519 were reached. Among these depressed individuals, 19.7% (102 of 519) had an unmet need for psychological care. Participants with an unmet need were younger (p<0.001) and had higher total depression scores compared to the group with no need (p<0.001). They also scored higher on cognitive-affective symptoms (p<0.001), whereas somatic symptoms did not significantly differ (p = 0.232). Logistic regression revealed that cognitive-affective symptoms predicted an unmet need (p = 0.001). However, overall predictive capacity of type of depressive symptoms on care needs was weak. Conclusions Cognitive-affective symptoms of depression—but not somatic symptoms—were associated with an unmet need for psychological care among depressed individuals with diabetes. Future research is needed to reveal better predictors explaining the discrepancy between distress and low care needs in order to optimize screening procedures.
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Affiliation(s)
- L. J. van der Donk
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - J. Fleer
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R. Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
| | - P. M. G. Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - T. P. Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - K. A. Tovote
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M. J. Schroevers
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Kerman HM, Deshpande BR, Selzer F, Losina E, Katz JN. Willingness of older adults to participate in a randomized trial of conservative therapies for knee pain: A prospective preference assessment. Contemp Clin Trials Commun 2018; 9:93-97. [PMID: 29696230 PMCID: PMC5898571 DOI: 10.1016/j.conctc.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/08/2017] [Accepted: 12/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background In preparation for a trial of physical therapy (PT) for patients with degenerative meniscal tear and knee osteoarthritis, we conducted a prospective preference assessment -- a methodology for estimating the proportion of eligible subjects who would participate in a hypothetical randomized trial. Methods We identified patients seeking care from the practices of five orthopedic surgeons. Patients completed a survey asking about their willingness to participate in a hypothetical trial, their treatment preferences, their knee pain, and demographic variables. Results We approached 201 eligible patients, of whom 67% (95% confidence interval [CI] 60%, 73%) completed questionnaires. Of these, 24% (95% CI 17%, 31%) were definitely and 39% (95% CI 31%, 47%) were probably willing to participate in the trial. Thirty-three percent (95% CI 23%, 43%) of subjects with no treatment preference were definitely willing to participate as compared to 9% (95% CI 1%, 17%) with treatment preference (p = .001). Patients with higher educational attainment also stated a greater willingness to participate than those with less education (p = .06). In multivariable logistic regression analysis, those with no treatment preferences had greater adjusted odds of stating they would definitely participate than those with a defined treatment preference (OR 5.2, 95% CI 1.7, 16.2), while subjects with an associate's degree or greater were more likely to state they would definitely participate than those with less education (OR 3.9, 95% CI 1.1, 14.1). Conclusion In this prospective preference assessment, 63% (95% CI 55%, 71%) of subjects with degenerative meniscal tear expressed willingness to participate in a trial of PT modalities. Individuals with no treatment preferences were more likely to state they would participate than were those with higher education. This methodology can help investigators estimate recruitment rates, anticipate generalizability of the trial sample and create strategies to facilitate enrollment.
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Affiliation(s)
- Hannah M Kerman
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Bhushan R Deshpande
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Proudfoot J, Clarke J, Gunn J, Fletcher S, Sanatkar S, Wilhelm K, Campbell L, Zwar N, Harris M, Lapsley H, Hadzi-Pavlovic D, Christensen H. A Web-Based Public Health Intervention to Reduce Functional Impairment and Depressive Symptoms in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial Protocol. JMIR Res Protoc 2017; 6:e145. [PMID: 28778848 PMCID: PMC5561386 DOI: 10.2196/resprot.7348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023] Open
Abstract
Background Depressive symptoms are common in people with type 2 diabetes and contribute to adverse health consequences that substantially impact social and vocational function. Despite the existence of effective depression treatments, the majority of people with type 2 diabetes do not access these when needed. Web-based alternatives to more traditional psychotherapies offer a potential solution to reducing the personal and economic burdens of type 2 diabetes. Objective This paper outlines the protocol for a randomized controlled trial (RCT) of myCompass, a Web-based public health psychotherapy intervention, in people with type 2 diabetes. Fully automated, interactive, and delivered via the Internet without clinician support, myCompass teaches cognitive behavioral therapy-based skills and supports symptom monitoring to improve daily functioning and reduce mild-to-moderate mental health symptoms. Methods A two-arm RCT will be conducted. People with type 2 diabetes and mild-to-moderately severe depressive symptoms will be recruited from the community and general practice settings. Screening and enrollment is via an open-access website. Participants will be randomized to use either myCompass or an active placebo program for 8 weeks, followed by a 4-week tailing-off period. The placebo program is matched to myCompass on mode of delivery, interactivity, and duration. Outcomes will be assessed at baseline and at 3-month, 6-month, and 12-month follow-up. The primary study outcome is work and social functioning. Secondary study outcomes include depressive and anxious symptoms, diabetes-related distress, self-care behaviors, and glycemic control. Results Nationwide recruitment is currently underway with the aim of recruiting 600 people with type 2 diabetes. Recruitment will continue until October 2017. Conclusions This is the first known trial of a Web-based psychotherapy program that is not diabetes specific for improving social and vocational function in people with type 2 diabetes and mild-to-moderately severe depressive symptoms. With the increasing prevalence of type 2 diabetes and depression, a potentially scalable public health intervention could play a very large role in reducing unmet mental health need and ameliorating the personal and societal impact of illness comorbidity. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109 (Archived by WebCite at http://www.webcitation.org/ 6rh3imVMh)
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Affiliation(s)
- Judy Proudfoot
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | | | - Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Susan Fletcher
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | | | - Kay Wilhelm
- School of Psychiatry, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Lesley Campbell
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Nicholas Zwar
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Helen Lapsley
- School of Psychiatry, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, Randwick, Australia.,School of Psychiatry, University of New South Wales (UNSW) Sydney, Sydney, Australia
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