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Joren CY, Kars MC, Kremer LCM, Rippen H, Verhagen AAE, Aris-Meijer JL. Improvement and implementation of a national individual care plan in paediatric palliative care: a study protocol. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001677. [PMID: 36697034 PMCID: PMC9884846 DOI: 10.1136/bmjpo-2022-001677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Paediatric palliative care (PPC) is care for children with life-threatening or life-limiting conditions, and can involve complex high-tech care, which can last for months or years. In 2015, the National Individual Care Plan (ICP) for PPC was developed and has shown to be successful. The ICP can be seen as an instrument to facilitate coordination, quality and continuity of PPC. However, in practice, an ICP is often completed too late and for too few children. We aim to improve the coordination, quality and continuity of care for every child with a life-threatening or life-limiting condition and his/her family by further developing and implementing the ICP in the Netherlands. METHODS AND ANALYSIS To evaluate the original ICP, ICP 1.0, interviews and questionnaires will be held among parents of children who have or have had an ICP 1.0 and healthcare professionals (HCPs) who used ICP 1.0. Based on the results, ICP 1.0 will be further developed. An implementation strategy will be written and the renewed ICP, ICP 2.0, will be nationally tested in an implementation period of approximately 7 months. During the implementation period, ICP 2.0 will be used for all children who are registered with Children's Palliative Care teams. After the implementation period, ICP 2.0 will be evaluated using interviews and questionnaires among parents of children who received ICP 2.0 and HPCs who worked with ICP 2.0. Based on these results, ICP 2.0 will be further optimised into the final version: ICP 3.0. ETHICS AND DISSEMINATION This study received ethical approval. The ICP 3.0 will be disseminated through the Dutch Centre of Expertise in Children's Palliative Care, to ensure wide availability for the general public and HCPs within PPC. Additionally, we aim to publish study results in open-access, peer-reviewed journals and to present results at national and international scientific meetings.
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Affiliation(s)
- Chantal Y Joren
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands .,Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Marijke C Kars
- Center of Expertise in Palliative Care Utrecht, Julius Center of Health and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Hester Rippen
- Dutch Foundation Child and Hospital, Utrecht, The Netherlands
| | - A A Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Judith L Aris-Meijer
- Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
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Beets MW, Pfledderer C, von Klinggraeff L, Burkart S, Armstrong B. Fund behavioral science like the frameworks we endorse: the case for increased funding of preliminary studies by the National Institutes of Health. Pilot Feasibility Stud 2022; 8:218. [PMID: 36171588 PMCID: PMC9516815 DOI: 10.1186/s40814-022-01179-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Innovative, groundbreaking science relies upon preliminary studies (aka pilot, feasibility, proof-of-concept). In the behavioral sciences, almost every large-scale intervention is supported by a series of one or more rigorously conducted preliminary studies. The importance of preliminary studies was established by the National Institutes of Health (NIH) in 2014/2015 in two translational science frameworks (NIH Stage and ORBIT models). These frameworks outline the essential role preliminary studies play in developing the next generation of evidence-based behavioral prevention and treatment interventions. Data produced from preliminary studies are essential to secure funding from the NIH’s most widely used grant mechanism for large-scale clinical trials, namely the R01. Yet, despite their unquestionable importance, the resources available for behavioral scientists to conduct rigorous preliminary studies are limited. In this commentary, we discuss ways the existing funding structure at the NIH, despite its clear reliance upon high-quality preliminary studies, inadvertently discourages and disincentivizes their pursuit by systematically underfunding them. We outline how multiple complementary and pragmatic steps via a small reinvestment of funds from larger trials could result in a large increase in funding for smaller preliminary studies. We make the case such a reinvestment has the potential to increase innovative science, increase the number of investigators currently funded, and would yield lasting benefits for behavioral science and scientists alike.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | | | | | - Sarah Burkart
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bridget Armstrong
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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3
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Daugherty SL, Helmkamp L, Vupputuri S, Hanratty R, Steiner JF, Blair IV, Dickinson LM, Maertens JA, Havranek EP. Effect of Values Affirmation on Reducing Racial Differences in Adherence to Hypertension Medication: The HYVALUE Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2139533. [PMID: 34913976 PMCID: PMC8678693 DOI: 10.1001/jamanetworkopen.2021.39533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Stereotype threat, or the fear of confirming a negative stereotype about one's social group, may contribute to racial differences in adherence to medications by decreasing patient activation to manage chronic conditions. OBJECTIVE To examine whether a values affirmation writing exercise improves medication adherence and whether the effect differs by patient race. DESIGN, SETTING, AND PARTICIPANTS The Hypertension and Values trial, a patient-level, blinded randomized clinical trial, compared an intervention and a control writing exercise delivered immediately prior to a clinic appointment. Of 20 777 eligible, self-identified non-Hispanic Black and White patients with uncontrolled hypertension who were taking blood pressure (BP) medications, 3891 were approached and 960 enrolled. Block randomization by self-identified race ensured balanced randomization. Patients enrolled between February 1, 2017, and December 31, 2019, at 11 US safety-net and community primary care clinics, with outcomes assessed at 3 and 6 months. Analysis was performed on an intention-to-treat basis. INTERVENTIONS From a list of 11 values, intervention patients wrote about their most important values and control patients wrote about their least important values. MAIN OUTCOMES AND MEASURES The primary outcome of adherence to BP medications was measured using pharmacy fill data (proportion of days covered >90%) at baseline, 3 months, and 6 months. The secondary outcome was systolic and diastolic BP. Patient activation to manage their health was also measured. RESULTS Of 960 patients, 474 (286 women [60.3%]; 256 Black patients [54.0%]; mean [SD] age, 63.4 [11.9] years) were randomly assigned to the intervention group and 486 (288 women [59.3%]; 272 Black patients [56.0%]; mean [SD] age, 62.8 [12.0] years) to the control group. Baseline medication adherence was lower (318 of 482 [66.0%] vs 331 of 412 [80.3%]) and mean (SE) BP higher among Black patients compared with White patients (systolic BP, 140.6 [18.5] vs 137.3 [17.8] mm Hg; diastolic BP, 83.9 [12.6] vs 79.7 [11.3] mm Hg). Compared with baseline, pharmacy fill adherence did not differ between intervention and control groups at 3 months (odds ratio [OR], 0.91 [95% CI, 0.57-1.43]) or at 6 months (OR, 0.86 [95% CI, 0.53-1.38]). There were also no treatment effect differences in pharmacy fill adherence by patient race (Black patients at 3 months: OR, 1.08 [95% CI, 0.61-1.92]; at 6 months: OR, 1.04 [95% CI, 0.58-1.87]; White patients at 3 months: OR, 0.68 [95% CI, 0.33-1.44]; at 6 months: OR, 0.55 [95% CI, 0.24-1.27]). Immediately after the intervention, the median patient activation was higher in intervention patients than in control patients, but this difference was not statistically significant in an unadjusted comparison (75.0 [IQR, 65.5-84.8] vs 72.5 [IQR, 63.1-80.9]; P = .06). In adjusted models, the Patient Activation Measure score immediately after the intervention was significantly higher in the intervention patients than in control patients (mean difference, 2.3 [95% CI, 0.1-4.5]). CONCLUSIONS AND RELEVANCE A values affirmation intervention was associated with higher patient activation overall but did not improve adherence or blood pressure among Black and White patients with hypertension. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03028597.
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Affiliation(s)
- Stacie L. Daugherty
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- Adult and Children Center for Outcomes Research and Delivery Sciences, University of Colorado, Aurora
- Colorado Cardiovascular Outcomes Research Group, University of Colorado, Aurora, Denver
| | - Laura Helmkamp
- Adult and Children Center for Outcomes Research and Delivery Sciences, University of Colorado, Aurora
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Rebecca Hanratty
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver
| | - Irene V. Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder
| | - L. Miriam Dickinson
- Adult and Children Center for Outcomes Research and Delivery Sciences, University of Colorado, Aurora
- Department of Family Medicine, University of Colorado School of Medicine, Aurora
| | - Julie A. Maertens
- Adult and Children Center for Outcomes Research and Delivery Sciences, University of Colorado, Aurora
| | - Edward P. Havranek
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- Adult and Children Center for Outcomes Research and Delivery Sciences, University of Colorado, Aurora
- Colorado Cardiovascular Outcomes Research Group, University of Colorado, Aurora, Denver
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
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Marseille BR, Commodore-Mensah Y, Davidson PM, Baker D, D'Aoust R, Baptiste DL. Improving hypertension knowledge, medication adherence, and blood pressure control: A feasibility study. J Clin Nurs 2021; 30:2960-2967. [PMID: 33872425 DOI: 10.1111/jocn.15803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension. BACKGROUND Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension. DESIGN Pre-test and post-test feasibility study. METHODS A convenience sample of forty-four participants who identified as Haitian immigrants was enrolled in this evidence-based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill-Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes. RESULTS Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six-week follow-up period. CONCLUSION The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in-depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities. RELEVANCE TO CLINICAL PRACTICE Advanced practice nurses are uniquely qualified to implement evidence-based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence-based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.
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Affiliation(s)
- Beatrice Remy Marseille
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,School of Public Health, Johns Hopkins Bloomberg, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,School of Public Health, Johns Hopkins Bloomberg, Baltimore, MD, USA
| | | | - Deborah Baker
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Rita D'Aoust
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Diana-Lyn Baptiste
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Kim ES, Tkatch R, Martin D, MacLeod S, Sandy L, Yeh C. Resilient Aging: Psychological Well-Being and Social Well-Being as Targets for the Promotion of Healthy Aging. Gerontol Geriatr Med 2021; 7:23337214211002951. [PMID: 33816707 PMCID: PMC7995285 DOI: 10.1177/23337214211002951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 12/27/2022] Open
Abstract
Population aging is one of the most important social trends of the 21st century and in the United States, the number of people aged ≥65 is projected to increase by nearly 50% in the next 15 years. Most biomedical and public health efforts have focused on reducing harmful risk factors when targeting chronic disease—an approach that has contributed greatly to prevention and treatment programs. However, evidence suggests that the number of years lost to disability is increasing and historic gains we have made in life expectancy are eroding, and even reversing in some groups. As our society ages and grapples with these issues, expanding the focus to include resilience, as well as psychosocial assets in our prevention and treatment programs might help inform the multidisciplinary response effort we need. Here we synthesize research evaluating associations between different dimensions of psychological well-being (e.g., purpose in life, optimism, life satisfaction) and social well-being (e.g., structural, functional, quality) with chronic conditions. We also evaluate evidence around three biopsychosocial pathways hypothesized to underlie these associations. These factors are meaningful, measurable, and potentially modifiable; thus, further pursuing this line of inquiry might unveil innovative paths to enhancing the health of our rapidly aging society.
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Affiliation(s)
- Eric S Kim
- University of British Columbia, Vancouver, Canada
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6
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Saslow LR, Moskowitz JT, Mason AE, Daubenmier J, Liestenfeltz B, Missel AL, Bayandorian H, Aikens JE, Kim S, Hecht FM. Intervention Enhancement Strategies Among Adults With Type 2 Diabetes in a Very Low-Carbohydrate Web-Based Program: Evaluating the Impact With a Randomized Trial. JMIR Diabetes 2020; 5:e15835. [PMID: 32902391 PMCID: PMC7511867 DOI: 10.2196/15835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adults with type 2 diabetes may experience health benefits, including glycemic control and weight loss, from following a very low-carbohydrate, ketogenic (VLC) diet. However, it is unclear which ancillary strategies may enhance these effects. OBJECTIVE This pilot study aims to estimate the effect sizes of 3 intervention enhancement strategies (text messages, gifts, and breath vs urine ketone self-monitoring) that may improve outcomes of a 12-month web-based ad libitum VLC diet and lifestyle intervention for adults with type 2 diabetes. The primary intervention also included other components to improve adherence and well-being, including positive affect and mindfulness as well as coaching. METHODS Overweight or obese adults (n=44; BMI 25-45 kg/m2) with type 2 diabetes (glycated hemoglobin [HbA1c] ≥6.5%), who had been prescribed either no glucose-lowering medications or metformin alone, participated in a 12-month web-based intervention. Using a 2×2×2 randomized factorial design, we compared 3 enhancement strategies: (1) near-daily text messages about the intervention's recommended behaviors (texts n=22 vs no texts n=22), (2) mailed gifts of diet-relevant foods and cookbooks (6 rounds of mailed gifts n=21 vs no gifts n=23), and (3) urine- or breath-based ketone self-monitoring (urine n=21 vs breath n=23). We assessed HbA1c and weight at baseline and at 4, 8, and 12 months. We evaluated whether each strategy exerted a differential impact on HbA1c and weight at 12 months against an a priori threshold of Cohen d of 0.5 or greater. RESULTS We retained 73% (32/44) of the participants at 12 months. The intervention, across all conditions, led to improvements in glucose control and reductions in body weight at the 12-month follow-up. In intent-to-treat (ITT) analyses, the mean HbA1c reduction was 1.0% (SD 1.6) and the mean weight reduction was 5.3% (SD 6.0), whereas among study completers, these reductions were 1.2% (SD 1.7) and 6.3% (SD 6.4), respectively, all with a P value of less than .001. In ITT analyses, no enhancement strategy met the effect size threshold. Considering only study completers, 2 strategies showed a differential effect size of at least a d value of 0.5 or greater. CONCLUSIONS Text messages, gifts of food and cookbooks, and urine-based ketone self-monitoring may potentially enhance the glycemic or weight loss benefits of a web-based VLC diet and lifestyle intervention for individuals with type 2 diabetes. Future research could investigate other enhancement strategies to help create even more effective solutions for the treatment of type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT02676648; http://clinicaltrials.gov/ct2/show/NCT02676648.
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Affiliation(s)
- Laura R Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Ashley E Mason
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Daubenmier
- Department of Health Education, San Francisco State University, San Francisco, CA, United States
| | - Bradley Liestenfeltz
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Amanda L Missel
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Kim
- Division of Endocrinology, Diabetes and Metabolism, University of California, San Francisco, San Francisco, CA, United States
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, United States
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Shiloh S, Nudelman G. Exploring dimensions of health behaviors' representations. Psychol Health 2020; 35:1017-1032. [PMID: 32202152 DOI: 10.1080/08870446.2019.1707828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To discover underlying dimensions of health behavior representations and to suggest a new framework for their investigation.Methods: A total of 1709 participants rated 45 health behaviors on 14 theoretical constructs denoting features by which individuals can cognitively represent health behaviors. Correlations among constructs were aggregated across behaviors using a meta-analytic approach, and subjected to factor analysis.Results: The analysis resulted in three interpretable dimensions: 'Importance', 'Negative Experience' and 'Ease', and one tentative factor, 'Other'.Conclusion: 'Importance', 'Negative Experience' and 'Ease' may be considered key dimensions for studying perceptions of health behaviors within a self-regulatory framework. These dimensions suggest new integrative and parsimonious ways for investigating health behaviors. The findings also highlight the importance of expanding the category of health behaviors to include psycho-social behaviors (e.g. stress management, social relationships), and the need for theoretical refinement of affective constructs anticipated during and after performance of health behaviors. This may improve the understanding and potential modification of health behaviors.
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Affiliation(s)
- Shoshana Shiloh
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Nudelman
- Department of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
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Roles of egos' and siblings' perceptions of maternal favoritism in adult children's depressive symptoms: A within-family network approach. ACTA ACUST UNITED AC 2019; 8:271-289. [PMID: 33777395 DOI: 10.1017/nws.2019.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It is well documented that intergenerational ties play important roles in adults' well-being. However, most studies focus on the impact of individuals' own perceptions of their ties without considering whether family members' assessments of these ties affect well-being. We address this question using data from 296 adult children nested within 95 later-life families in which all offspring were interviewed. Applying a mixed-method within-family approach, we explored whether the effect of perceived maternal favoritism on depressive symptoms was increased when siblings shared ego's perceptions. Multilevel regression analyses revealed that ego's own perceptions predicted depressive symptoms, but only among daughters. Siblings' perceptions that egos were most close to mothers did not affect the well-being of daughters or sons. Qualitative analyses suggested that differential effects of perceived favoritism by gender reflected differences in the meaning sons and daughters associated with being favored children. Favored daughters were more likely than favored sons to report that they were emotional caregivers to their mothers; this pattern was especially strong when siblings reinforced egos' perceptions of being "best suited" for this role. These findings emphasize the salience of egos' own perceptions, relative to those of family network members, in shaping role embracement and psychological well-being, especially among women.
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Salsman JM, Pustejovsky JE, Schueller SM, Hernandez R, Berendsen M, McLouth LES, Moskowitz JT. Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect. J Cancer Surviv 2019; 13:943-955. [PMID: 31741250 DOI: 10.1007/s11764-019-00811-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/21/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Positive affect has demonstrated unique benefits in the context of health-related stress and is emerging as an important target for psychosocial interventions. The primary objective of this meta-analysis was to determine whether psychosocial interventions increase positive affect in cancer survivors. METHODS We coded 28 randomized controlled trials of psychosocial interventions assessing 2082 cancer survivors from six electronic databases. We calculated 76 effect sizes for positive affect and conducted synthesis using random effects models with robust variance estimation. Tests for moderation included demographic, clinical, and intervention characteristics. RESULTS Interventions had a modest effect on positive affect (g = 0.35, 95% CI [0.16, 0.54]) with substantial heterogeneity of effects across studies ([Formula: see text]; I2 = 78%). Three significant moderators were identified: in-person interventions outperformed remote interventions (P = .046), effects were larger when evaluated against standard of care or wait list control conditions versus attentional, educational, or component controls (P = .009), and trials with survivors of early-stage cancer diagnoses yielded larger effects than those with advanced-stage diagnoses (P = .046). We did not detect differential benefits of psychosocial interventions across samples varying in sex, age, on-treatment versus off-treatment status, or cancer type. Although no conclusive evidence suggested outcome reporting biases (P = .370), effects were smaller in studies with lower risk of bias. CONCLUSIONS In-person interventions with survivors of early-stage cancers hold promise for enhancing positive affect, but more methodological rigor is needed. IMPLICATIONS FOR CANCER SURVIVORS Positive affect strategies can be an explicit target in evidence-based medicine and have a role in patient-centered survivorship care, providing tools to uniquely mobilize human strengths.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, 27157, USA.
| | - James E Pustejovsky
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Mark Berendsen
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie E Steffen McLouth
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, 27157, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Moskowitz JT, Addington EL, Cheung EO. Positive psychology and health: Well-being interventions in the context of illness. Gen Hosp Psychiatry 2019; 61:136-138. [PMID: 31757566 DOI: 10.1016/j.genhosppsych.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States of America.
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States of America
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States of America
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11
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Carbonnel F, Ninot G. Identifying Frameworks for Validation and Monitoring of Consensual Behavioral Intervention Technologies: Narrative Review. J Med Internet Res 2019; 21:e13606. [PMID: 31621638 PMCID: PMC6822061 DOI: 10.2196/13606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/08/2019] [Accepted: 08/02/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Changing health behaviors, such as smoking, unhealthy eating, inactivity, and alcohol abuse, may have a greater impact on population health than any curative strategy. One of the suggested strategies is the use of behavioral intervention technologies (BITs). They open up new opportunities in the area of prevention and therapy and have begun to show benefits in the durable change of health behaviors in patients or those at risk. A consensual and international paradigm was adopted by health authorities for drugs 50 years ago. It guides their development from research units to their authorization and surveillance. BITs' generalization brings into question their upstream evaluation before being placed on the market and their downstream monitoring once on the market; this is especially the case in view of the marketing information provided by manufacturers and the scarcity and methodological limits of scientific studies on these tools. OBJECTIVE This study aims to identify and categorize the frameworks for the validation and monitoring of BITs proposed in the literature. METHODS We conducted a narrative literature review using MEDLINE, PsycINFO, and Web of Science. The review items included the following: name, publication year, name of the creator (ie, first author), country, funding organization, health focus, target group, and design (ie, linear, iterative, evolutive, and/or concurrent). The frameworks were then categorized based on (1) translational research thanks to a continuum of steps and (2) the three paradigms that may have inspired the frameworks: biomedical, engineering, and/or behavioral. RESULTS We identified 46 frameworks besides the classic US Food and Drug Administration (FDA) five-phase drug development model. A total of 57% (26/46) of frameworks were created in the 2010s and 61% (28/46) involved the final user in an early and systematic way. A total of 4% (2/46) of frameworks had a linear-only sequence of their phases, 37% (17/46) had a linear and iterative structure, 33% (15/46) added an evolutive structure, and 24% (11/46) were associated with a parallel process. Only 12 out of 46 (26%) frameworks covered the continuum of steps and 12 (26%) relied on the three paradigms. CONCLUSIONS To date, 46 frameworks of BIT validation and surveillance coexist, besides the classic FDA five-phase drug development model, without the predominance of one of them or convergence in a consensual model. Their number has increased exponentially in the last three decades. Three dangerous scenarios are possible: (1) anarchic continuous development of BITs that depend on companies amalgamating health benefits and usability (ie, user experience, data security, and ergonomics) and limiting implementation to several countries; (2) the movement toward the type of framework for drug evaluation centered on establishing its effectiveness before marketing authorization to guarantee its safety for users, which is heavy and costly; and (3) the implementation of a framework reliant on big data analysis based on a posteriori research and an autoregulation of a market, but that does not address the safety risk for the health user, as the market will not regulate safety or efficacy issues. This paper recommends convergence toward an international validation and surveillance framework based on the specificities of BITs, not equivalent to medical devices, to guarantee their effectiveness and safety for users.
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Affiliation(s)
- François Carbonnel
- Research Unit EA4556 Epsylon, University of Montpellier, Montpellier, France.,Plateforme Universitaire Collaborative d'Evaluation des Programmes de Prévention et de Soins de Support, University of Montpellier, Montpellier, France.,University Department of General Practice, University of Montpellier, Montpellier, France.,University Multiprofessional Health Center Avicenne, Perpignan, France
| | - Gregory Ninot
- Research Unit EA4556 Epsylon, University of Montpellier, Montpellier, France.,Plateforme Universitaire Collaborative d'Evaluation des Programmes de Prévention et de Soins de Support, University of Montpellier, Montpellier, France.,Montpellier Cancer Institute, Montpellier, France
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12
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Moskowitz JT, Cheung EO, Snowberg KE, Verstaen A, Merrilees J, Salsman JM, Dowling GA. Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers. Health Psychol 2019; 38:391-402. [PMID: 31045422 PMCID: PMC6501812 DOI: 10.1037/hea0000680] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To test the effects of Life Enhancing Activities for Family Caregivers (LEAF), a 6-week positive emotion regulation intervention, on outcomes of positive emotion, depression, anxiety, and physical health as measured by the Patient-Reported Outcomes Measurement Information System® (PROMIS®). METHOD A randomized controlled trial (N = 170) comparing LEAF (N = 86) to an emotion reporting/waitlist condition (N = 84) in dementia caregivers. LEAF was individually delivered online by trained facilitators. Participants in the control condition completed daily online emotion reports and then crossed over into the intervention condition after 6 weeks. The study was registered with Clinicaltrials.gov (NCT01825681) and funded by R01NR014435. RESULTS Analyses of difference in change from baseline to 6 weeks demonstrated significantly greater decreases in PROMIS® depression (d = -.25; p = .02) and Quality of Life in Neurological Disorders (NeuroQOL) anxiety (d = -.33; p < .01), as well as improvements in PROMIS® physical health (d = .24; p = .02) in the intervention condition compared to the emotion reporting/waitlist control. The intervention also showed greater improvements in positive emotion (d = .58; p < .01) and positive aspects of caregiving (d = .36; p < .01). Increases in positive emotion significantly mediated the effect of LEAF on depression over time. CONCLUSIONS This randomized controlled trial of the online-facilitated positive emotion regulation intervention in dementia caregivers demonstrated small to medium effect sizes on caregiver well-being and shows promise for remotely delivered programs to improve psychological well-being in caregivers of people with dementia and other chronic illnesses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Karin E Snowberg
- Department of Physiological Nursing, University of California, San Francisco
| | - Alice Verstaen
- Department of Psychology, University of California, Berkeley
| | | | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California, San Francisco
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13
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Pressman SD, Jenkins BN, Moskowitz JT. Positive Affect and Health: What Do We Know and Where Next Should We Go? Annu Rev Psychol 2019; 70:627-650. [DOI: 10.1146/annurev-psych-010418-102955] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Positive affect (PA) is associated with better health across a wide range of physical health outcomes. This review reflects on why the study of PA is an essential component of our understanding of physical health and expands on pathways that connect these two variables. To encourage forward movement in this burgeoning research area, measurement and design issues in the study of PA and health are discussed, as are the connections between PA and a range of different health outcomes. Plausible biological, social, and behavioral pathways that allow for positive feelings to get under the skin and influence physical wellness are detailed and framed in the context of several theoretical models. Finally, new directions for the field and important methodological and interpretative considerations that are essential to moving this important research area forward are explored.
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Affiliation(s)
- Sarah D. Pressman
- Department of Psychological Science, University of California, Irvine, California 92697, USA
| | - Brooke N. Jenkins
- Department of Psychology, Chapman University, Orange, California 92866, USA
| | - Judith T. Moskowitz
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
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14
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Mateo KF, Berner NB, Ricci NL, Seekaew P, Sikerwar S, Tenner C, Dognin J, Sherman SE, Kalet A, Jay M. Development of a 5As-based technology-assisted weight management intervention for veterans in primary care. BMC Health Serv Res 2018; 18:47. [PMID: 29378584 PMCID: PMC5789563 DOI: 10.1186/s12913-018-2834-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams. Methods Thematic analyses of prior formative work (focus groups with patients [n = 54] and key informant interviews with staff [n = 25]) helped to create a technology-assisted, health coaching intervention called Goals for Eating and Moving (GEM). To further develop the intervention, we then conducted two rounds of testing with previous formative study participants (n = 5 for Round 1, n = 5 for Round 2). Each session included usability testing of prototypes of the online GEM tool, pilot testing of 5As counseling by a Health Coach, and a post-session open-ended interview. Results Three main themes emerged from usability data analyses: participants’ emotional responses, tool language, and health literacy. Findings from both rounds of usability testing, pilot testing, as well as the open-ended interview data, were used to finalize protocols for the full intervention in the clinic setting to be conducted with Version 3 of the GEM tool. Conclusions The use of qualitative research methods and user-centered design approaches enabled timely detection of salient issues to make iterative improvements to the intervention. Future studies will determine whether this intervention can increase enrollment in intensive weight management programs and promote clinically meaningful weight loss in both Veterans and in other patient populations and health systems.
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Affiliation(s)
- Katrina F Mateo
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Natalie B Berner
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Natalie L Ricci
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Pich Seekaew
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Sandeep Sikerwar
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Craig Tenner
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Joanna Dognin
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA
| | - Scott E Sherman
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA.,New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Adina Kalet
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Melanie Jay
- VA NY Harbor Healthcare System, Manhattan Campus 423 East 23rd Street, New York, NY, 10010, USA. .,New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
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15
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Allegrante JP. Advancing the Science of Behavioral Self-Management of Chronic Disease: The Arc of a Research Trajectory. HEALTH EDUCATION & BEHAVIOR 2017; 45:6-13. [PMID: 29258348 DOI: 10.1177/1090198117749010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes advances in the behavioral self-management of chronic disease from the perspective of a 25-year trajectory of National Institute of Health-funded research in arthritis and cardiopulmonary diseases that has sought to develop a transdisciplinary understanding of how applied behavioral science can be used to improve health behaviors, functional status, and health outcomes. The article traces the arc of a novel research program-conducted in collaboration with physician-scientists at Columbia, Weill Cornell Medical College, and New York University School of Medicine-that runs through social cognitive theory, behavioral economics, and the emerging science of positive psychology in an effort to develop promising new approaches to fostering the adoption and maintenance of health-related behavioral change. The article concludes with what has been learned and what the implications of the work are for advancing behavioral self-management and patient education to improve patient outcomes and achieve the compression of morbidity.
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Affiliation(s)
- John P Allegrante
- 1 Teachers College and the Mailman School of Public Health, Columbia University, New York, NY, USA
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16
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Ironson G, Banerjee N, Fitch C, Krause N. Positive emotional well-being, health Behaviors, and inflammation measured by C-Reactive protein. Soc Sci Med 2017; 197:235-243. [PMID: 28701268 DOI: 10.1016/j.socscimed.2017.06.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is a substantial body of literature describing the association between inflammatory biomarkers and negative emotional factors (i.e. depression). However, less is known about how they might be related to positive psychological variables. This study examined the association between positive emotional well-being (PEWB) and C-Reactive Protein (CRP), an inflammatory biomarker important for cardiovascular and other diseases. METHOD Data were analyzed from 1979 respondents to a nationwide survey in the U.S., which included a chronically ill subgroup. Two aspects of PEWB were assessed; positive affect and life satisfaction. CRP was analyzed via blood-spot from a finger-prick. The mediating role of health behaviors (i.e., smoking, alcohol, BMI, and moderate exercise) was also examined. RESULTS Both positive affect and life satisfaction were significantly related to lower CRP even after controlling for demographics and depression, in both the overall sample and chronically ill group. Only life satisfaction remained significantly related to CRP when controlling for health behaviors. When both depression and health behaviors were controlled, neither positive affect nor life satisfaction was significantly related to CRP. Moderate exercise emerged as the strongest mediator, followed by BMI and smoking. Individuals with low positive affect or low life satisfaction were at increased odds (OR = 1.40 and OR = 1.54, respectively) of having clinically elevated (≥3 mg/L) CRP. CONCLUSION Our results add to a growing literature reporting an association between aspects of PEWB, especially life satisfaction, and a health-related biomarker of inflammation. Those with low positive affect or life satisfaction face increased risk of having clinically elevated CRP. Health behaviors, especially BMI and moderate exercise, account for some but not all of this relationship. Future studies should determine whether increasing life satisfaction and positive affect may contribute to improvements in health behaviors, inflammation, and better health outcomes.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, United States.
| | - Nikhil Banerjee
- Department of Psychology, University of Miami, Coral Gables, United States
| | - Calvin Fitch
- Department of Psychology, University of Miami, Coral Gables, United States
| | - Neal Krause
- School of Public Health, University of Michigan, Ann Arbor, United States
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17
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Moskowitz JT, Carrico AW, Duncan LG, Cohn MA, Cheung EO, Batchelder A, Martinez L, Segawa E, Acree M, Folkman S. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol 2017; 85:409-423. [PMID: 28333512 DOI: 10.1037/ccp0000188] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV. METHOD One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition. RESULTS For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes. CONCLUSIONS This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record
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Affiliation(s)
- Judith T Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami
| | - Larissa G Duncan
- Human Development and Family Studies, University of Wisconsin-Madison
| | - Michael A Cohn
- Osher Center for Integrative Medicine, University of California San Francisco
| | - Elaine O Cheung
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Abigail Batchelder
- Osher Center for Integrative Medicine, University of California San Francisco
| | - Lizet Martinez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Eisuke Segawa
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Michael Acree
- Department of Medicine, University of California San Francisco
| | - Susan Folkman
- Department of Medicine, University of California San Francisco
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18
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Online support groups for young women with breast cancer: a proof-of-concept study. Support Care Cancer 2017; 25:2285-2296. [DOI: 10.1007/s00520-017-3639-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/10/2017] [Indexed: 11/25/2022]
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19
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Hawkins A, Evangeli M, Sturgeon K, Le Prevost M, Judd A. Episodic medication adherence in adolescents and young adults with perinatally acquired HIV: a within-participants approach. AIDS Care 2016; 28 Suppl 1:68-75. [PMID: 26886514 PMCID: PMC4828603 DOI: 10.1080/09540121.2016.1146210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/20/2016] [Indexed: 11/24/2022]
Abstract
Due to the success of antiretroviral (ART) medications, young people living with perinatally acquired HIV (PHIV+) are now surviving into adolescence and young adulthood. Understanding factors influencing ART non-adherence in this group is important in developing effective adherence interventions. Most studies of ART adherence in HIV-positive populations assess differences in adherence levels and adherence predictors between participants, over a period of time (global adherence). Many individuals living with HIV, however, including PHIV+ young people, take medication inconsistently. To investigate this pattern of adherence, a within-participants design, focussing on specific episodes of adherence and non-adherence, is suitable (episodic adherence). A within-participants design was used with 29 PHIV+ young people (17 female, median age 17 years, range 14-22 years), enrolled in the UK Adolescents and Adults Living with Perinatal HIV cohort study. Participants were eligible if they could identify one dose of medication taken and one dose they had missed in the previous two months. For each of the two episodes (one adherent, one non-adherent), behavioural factors (whom they were with, location, routine, day, reminders) and psychological factors at the time of the episode (information about medication, adherence motivation, perceived behavioural skills to adhere to medication - derived from the Information-Motivation-Behavioural Skills (IMB) Model - and affect) were assessed in a questionnaire. Non-adherence was significantly associated with weekend days (Friday to Sunday versus Monday to Thursday, p = .001), lack of routine (p = .004), and being out of the home (p = .003), but not with whom the young person was with or whether they were reminded to take medication. Non-adherence was associated with lower levels of behavioural skills (p < .001), and lower positive affect (p = .005). Non-adherence was not significantly associated with negative affect, information about ART, or ART motivation. The use of situationally specific strategies to enhance adherence in young people who take their medication inconsistently is proposed.
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Affiliation(s)
- Amy Hawkins
- Department of Psychology, Royal Holloway University of London, Surrey, UK
| | - Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Surrey, UK
| | - Kate Sturgeon
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, UCL, London, UK
| | - Marthe Le Prevost
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, UCL, London, UK
| | - Ali Judd
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, UCL, London, UK
| | - on behalf of the AALPHI Steering Committee
- Department of Psychology, Royal Holloway University of London, Surrey, UK
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, UCL, London, UK
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20
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Czajkowski SM, Powell LH, Adler N, Naar-King S, Reynolds KD, Hunter CM, Laraia B, Olster DH, Perna FM, Peterson JC, Epel E, Boyington JE, Charlson ME. From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol 2015; 34:971-82. [PMID: 25642841 PMCID: PMC4522392 DOI: 10.1037/hea0000161] [Citation(s) in RCA: 572] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases. METHOD The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization. RESULTS This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases. CONCLUSIONS The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record
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Affiliation(s)
- Susan M Czajkowski
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Lynda H Powell
- Department of Preventive Medicine, Rush University Medical Center
| | - Nancy Adler
- Department of Psychiatry, Center for Health and Community, University of California, San Francisco
| | | | - Kim D Reynolds
- School of Community and Global Health, Claremont Graduate University
| | - Christine M Hunter
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | - Barbara Laraia
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley
| | - Deborah H Olster
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health
| | - Frank M Perna
- Behavioral Research Program, National Cancer Institute, National Institutes of Health
| | | | - Elissa Epel
- Department of Psychiatry, Center for Health and Community, University of California, San Francisco
| | - Josephine E Boyington
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Mary E Charlson
- Center for Integrative Medicine, Weill Cornell Medical College
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21
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Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group. Behav Res Ther 2015; 69:75-82. [PMID: 25898342 DOI: 10.1016/j.brat.2015.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/26/2015] [Accepted: 04/11/2015] [Indexed: 11/22/2022]
Abstract
To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options.
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22
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Phillips-Caesar EG, Winston G, Peterson JC, Wansink B, Devine CM, Kanna B, Michelin W, Wethington E, Wells M, Hollenberg J, Charlson ME. Small Changes and Lasting Effects (SCALE) Trial: the formation of a weight loss behavioral intervention using EVOLVE. Contemp Clin Trials 2015; 41:118-28. [PMID: 25633208 PMCID: PMC4492122 DOI: 10.1016/j.cct.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
Abstract
Background Obesity is a major health problem that disproportionately affects Black and Hispanic adults. This paper presents the rationale and innovative design of a small change eating and physical activity intervention (SC) combined with a positive affect and self-affirmation (PA/SA) intervention versus the SC intervention alone for weight loss. Methods Using a mixed methods translational model (EVOLVE), we designed and tested a SC approach intervention in overweight and/ or obese African American and Hispanic adults. In Phase I, we explored participant’s values and beliefs about the small change approach. In Phase II, we tested and refined the intervention and then, in Phase III we conducted a RCT. Participants were randomized to the SC approach with PA/SA intervention vs. a SC approach alone for 12 months. The primary outcome was clinically significant weight loss at 12 months. Results Over 4.5 years a total of 574 participants (67 in Phase I, 102 in Phase II and 405 in Phase III) were enrolled. Phase I findings were used to create a workbook based on real life experiences about weight loss and to refine the small change eating strategies. Phase II results shaped the recruitment and retention strategy for the RCT, as well as the final intervention. The RCT results are currently under analysis. Conclusion The present study seeks to determine if a SC approach combined with a PA/SA intervention will result in greater weight loss at 12 months in Black and Hispanic adults compared to a SC approach alone.
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Affiliation(s)
- Erica G Phillips-Caesar
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801.
| | - Ginger Winston
- George Washington University, Department of Medicine, Foggy Bottom South Pavilion, 22nd & I Street, NW Washington DC 20037
| | - Janey C Peterson
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801
| | - Brian Wansink
- Department of Human Development, Cornell University G96 Martha Van Rensselaer Hall Ithaca, NY 14853-4401
| | - Carol M Devine
- Division of Nutritional Sciences, Cornell University 405 Savage Hall Cornell University Ithaca, NY 14853-4401
| | - Balavanketsh Kanna
- Lincoln Medical and Mental Health Center for Collaborative Community Research
| | - Walid Michelin
- Lincoln Medical and Mental Health Center for Collaborative Community Research
| | - Elaine Wethington
- Department of Human Development, Cornell University G96 Martha Van Rensselaer Hall Ithaca, NY 14853-4401
| | - Martin Wells
- Cornell University Department of Statistical Science 301 Malott Hall Ithaca, NY 14853
| | - James Hollenberg
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801
| | - Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801
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Peterson JC, Charlson ME, Wells MT, Altemus M. Depression, coronary artery disease, and physical activity: how much exercise is enough? Clin Ther 2014; 36:1518-30. [PMID: 25456561 PMCID: PMC4311731 DOI: 10.1016/j.clinthera.2014.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE The mechanisms by which depressive symptoms negatively affect clinical outcomes in patients with coronary artery disease (CAD) remain poorly understood. Previous interventions that have attempted to treat depressive symptoms in patients with CAD to improve their clinical outcomes have been disappointing. Our objectives were, among a cohort of CAD patients, to evaluate the impact of depressive symptoms over time, controlling for comorbidity, in determining both successful long-term lifestyle change (ie, increased physical activity), and cardiovascular morbidity and mortality outcomes. In addition, we examined the impact of physical activity changes over time on 2 known mediators of cardiovascular morbidity: parasympathetic tone and inflammation. METHODS Clinical data were previously collected (2004-2006) from 242 elective/urgent coronary angioplasty patients who participated in a prospective randomized controlled trial evaluating the efficacy of a behavioral intervention versus an educational control to motivate physical activity over 12 months. Exclusion criteria included: (1) inability to walk; (2) enrollment in other risk-reduction trials; (3) non-English speaking; and (4) lack of cardiologist's permission to increase physical activity. Participants were assessed every 2 months for interval clinical events and physical activity. In addition, biomarkers were collected at baseline and at 12 months in a subset of 54 participants; these biomarkers included low-frequency heart rate variability (lfHRV), high-frequency heart rate variability (hfHRV), serum C-reactive protein, interleukin-6, and salivary cortisol. FINDINGS The mean age of participants was 63 years and 30% were female. Overall, 37% had high depressive symptoms at baseline. Patients with high depressive symptoms who achieved an increase in physical activity of ≥336 kilocalories(kcal)/week by 12 months had significantly lower rates of cardiovascular morbidity/mortality (5.1% vs. 21.3%; odds ratio [OR], 0.20, [95% CI, 0.04-0.98]; P = 0.03). In a multivariate model examining cardiovascular morbidity/mortality in patients with high depressive symptoms, an increase in physical activity of ≥336 kcal/week reduced the risk of new cardiovascular morbidity/mortality (OR, 0.11 [95% CI, 0.02-0.81]; P < 0.03), and comorbidity increased the risk (OR, 1.58 [95% CI, 1.18-2.13]; P = 0.002). In a generalized structural equation model, increasing physical activity by ≥336 kcal/week decreased the risk of complications, and comorbidity increased the risk. Furthermore, increasing physical activity (≥336 kcal/week) predicted an increase in hfHRV, a marker of parasympathetic tone, and the increase in hfHRV predicted a reduction in the proinflammatory mediators interleukin-6 and C-reactive protein. IMPLICATIONS This study found a threshold in physical activity in CAD patients with depressive symptoms that is associated with a decrease in cardiovascular morbidity and mortality. Exercise maintenance at this level may improve clinical outcomes via enhanced parasympathetic tone and decreased inflammation. ClinicalTrials.gov identifier: NCT00248846.
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Affiliation(s)
- Janey C. Peterson
- The Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, New York, NY USA
| | - Mary E. Charlson
- The Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, New York, NY USA,
| | - Martin T. Wells
- Departments of Statistical Science and Social Statistics, Cornell University, Ithaca, NY, USA,
| | - Margaret Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY USA,
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Klein WMP, Shepperd JA, Suls J, Rothman AJ, Croyle RT. Realizing the Promise of Social Psychology in Improving Public Health. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2014; 19:77-92. [DOI: 10.1177/1088868314539852] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The theories, phenomena, empirical findings, and methodological approaches that characterize contemporary social psychology hold much promise for addressing enduring problems in public health. Indeed, social psychologists played a major role in the development of the discipline of health psychology during the 1970s and 1980s. The health domain allows for the testing, refinement, and application of many interesting and important research questions in social psychology, and offers the discipline a chance to enhance its reach and visibility. Nevertheless, in a review of recent articles in two major social-psychological journals ( Personality and Social Psychology Bulletin and Journal of Personality and Social Psychology), we found that only 3.2% of 467 studies explored health-related topics. In this article, we identify opportunities for research at the interface of social psychology and health, delineate barriers, and offer strategies that can address these barriers as the discipline continues to evolve.
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Affiliation(s)
| | | | - Jerry Suls
- National Cancer Institute, Rockville, MD, USA
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25
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Cohn MA, Pietrucha ME, Saslow LR, Hult JR, Moskowitz JT. An online positive affect skills intervention reduces depression in adults with type 2 diabetes. JOURNAL OF POSITIVE PSYCHOLOGY 2014; 9:523-534. [PMID: 25214877 DOI: 10.1080/17439760.2014.920410] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Positive affect predicts improved glycemic control and longevity in adults with type 2 diabetes. We tested DAHLIA, a self-paced online intervention for type 2 diabetes that teaches positive affect skills such as savoring, gratitude, and acts of kindness. Participants (n=49) were randomized to the 5-week DAHLIA course or an emotion-reporting waitlist control. DAHLIA was understood and accepted by participants and showed good retention (78%). At post-intervention, DAHLIA participants showed a significantly greater decrease in depression than controls (-4.3 vs. +0.6 points on the CES-D, p =.05). Secondary analyses found that this effect was considerably stronger in intervention recipients recruited online than those recruited in person. Intervention recipients recruited online also showed significantly increased positive affect, reduced negative affect, and reduced perceived stress. There were no effects on measures of diabetes-specific efficacy or sense of burden, or preliminary measures of health behaviors. This successful feasibility and efficacy trial provides support for a larger trial focusing more specifically on health behavior.
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Affiliation(s)
- Michael A Cohn
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Martha E Pietrucha
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura R Saslow
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jen R Hult
- Clinical & Translational Science Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Judith T Moskowitz
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
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26
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Acevedo-Polakovich ID, Niec LN, Barnett ML, Bell KM, Aguilar G, Vilca J, Abbenante-Honold ES, Christian AS, Peer SO. Exploring the role of Natural Helpers in efforts to address disparities for children with conduct problems. CHILDREN AND YOUTH SERVICES REVIEW 2014; 40:1-5. [PMID: 24910488 PMCID: PMC4041872 DOI: 10.1016/j.childyouth.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The incorporation of natural helpers into services has been suggested as an innovative strategy to address disparities for historically underserved children with conduct problems. In order to inform incorporation efforts, this study examined the perceptions of natural helpers serving one U.S. Latina/o community regarding need for services for children with conduct problems, their reactions to a specific parent training intervention, and the training and support needed to deliver this intervention successfully. Participants identified a need for culturally-responsive services for children with conduct problems, and felt that parent training would be appropriate for the families they serve. Participants further identified specific training and support that they would require in order to deliver parent training with fidelity and effectiveness. Findings support the suggestion that natural helpers have the potential to address service disparities among Latina/o children with conduct problems. Recommendations from natural helpers should guide the development of culturally-adapted preventive interventions that help address existing service disparities.
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Affiliation(s)
| | - Larissa N Niec
- Central Michigan University Center for Children, Families and Communities
| | - Miya L Barnett
- Central Michigan University Center for Children, Families and Communities
| | | | | | - Jeanette Vilca
- Central Michigan University Center for Children, Families and Communities
| | | | | | - Samuel O Peer
- Central Michigan University Center for Children, Families and Communities
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27
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Peterson JC, Link AR, Jobe JB, Winston GJ, Marina Klimasiewfski E, Allegrante JP. Developing self-management education in coronary artery disease. Heart Lung 2014; 43:133-9. [PMID: 24373484 PMCID: PMC3947696 DOI: 10.1016/j.hrtlng.2013.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/16/2013] [Accepted: 11/17/2013] [Indexed: 11/22/2022]
Abstract
We describe a three-step approach to develop and evaluate a novel coronary artery disease (CAD) self-management educational workbook. First, we conducted interviews using grounded theory methods with a diverse CAD cohort (n = 61) to identify needs and perceptions. Second, we developed the workbook, incorporating themes that emerged from the qualitative interviews. Finally, 225 people with CAD used the workbook in a longitudinal study and we evaluated their use of and experience with the workbook at 12 months. 12-month evaluation data revealed that the workbook: provided practical health information; enhanced behavior-specific self-efficacy; and reinforced that healthy behaviors decrease risk. Participants who read the workbook had greater within-patient increases in physical activity at 12-months compared with non-readers (p = 0.093) and among Black/Hispanic participants, workbook readers' increases were significant (592 vs. -645 kilocalories per week, p = 0.035). A self-management educational workbook developed using qualitative methods can provide relevant, disease-specific health information for patients with CAD.
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Affiliation(s)
- Janey C Peterson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine & Department of Cardiothoracic Surgery, Weill Cornell Medical College, 1300 York Ave., Box 46, New York, NY 10065, USA.
| | - Alissa R Link
- Department of Population Health, New York University School of Medicine, USA; Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, USA
| | - Jared B Jobe
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, USA; Clinical Applications & Prevention Branch, Division of Prevention & Population Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, USA
| | - Ginger J Winston
- Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, USA
| | - E Marina Klimasiewfski
- Department of Nursing, Columbia University Medical Center, USA; Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, USA
| | - John P Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, USA
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28
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Gierisch JM, Fish LJ. Capsule commentary on Katz et al., Implementing smoking cessation guidelines for hospitalized veterans: effects on nurse attitudes and performance. J Gen Intern Med 2013; 28:1493. [PMID: 23739811 PMCID: PMC3797355 DOI: 10.1007/s11606-013-2503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA
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29
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Boutin-Foster C, Scott E, Melendez J, Rodriguez A, Ramos R, Kanna B, Michelen W. Ethical considerations for conducting health disparities research in community health centers: a social-ecological perspective. Am J Public Health 2013; 103:2179-84. [PMID: 24134347 DOI: 10.2105/ajph.2013.301599] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Community health centers (CHCs) provide optimal research settings. They serve a high-risk, medically underserved population in the greatest need of intervention. Low socioeconomic status renders this population particularly vulnerable to research misconduct. Traditional principles of research ethics are often applied to participants only. The social-ecological model offers a comprehensive framework for applying these principles across multiple levels (participants, providers, organizations, communities, and policy). Our experience with the Trial Using Motivational Interviewing, Positive Affect and Self-Affirmation in African-Americans with Hypertension, a randomized trial conducted in CHCs, led us to propose a new platform for discussing research ethics; examine the social, community, and political factors surrounding research conducted in CHCs; and recommend how future research should be conducted in such settings.
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Affiliation(s)
- Carla Boutin-Foster
- Carla Boutin-Foster, Ebony Scott, Rosio Ramos, and Anna Rodriguez are with the Division of Clinical Epidemiology and Evaluative Sciences, Weill Cornell Medical Center, New York, NY. Jennifer Melendez, Balavenkatesh Kanna, and Walid Michelen are with the Lincoln Center for Clinical and Community Research, Lincoln Hospital/Generations Plus Northern Manhattan Network, New York City Health and Hospitals Corporation, Bronx, NY
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30
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Boutin-Foster C, Scott E, Rodriguez A, Ramos R, Kanna B, Michelen W, Charlson M, Ogedegbe G. The Trial Using Motivational Interviewing and Positive Affect and Self-Affirmation in African-Americans with Hypertension (TRIUMPH): from theory to clinical trial implementation. Contemp Clin Trials 2013; 35:8-14. [PMID: 23403073 PMCID: PMC4128940 DOI: 10.1016/j.cct.2013.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/01/2013] [Accepted: 02/03/2013] [Indexed: 01/13/2023]
Abstract
This paper describes the application of a translational research model in developing The Trial Using Motivational Interviewing and Positive Affect and Self-Affirmation in African-Americans with Hypertension (TRIUMPH), a theoretically-based, randomized controlled trial. TRIUMPH targets blood pressure control among African-Americans with hypertension in a community health center and public hospital setting. TRIUMPH applies positive affect, self-affirmation, and motivational interviewing as strategies to increase medication adherence and blood pressure control. A total of 220 participants were recruited in TRIUMPH and are currently being followed. This paper provides a detailed description of the theoretical framework and study design of TRIUMPH and concludes with a critical reflection of the lessons learned in the process of implementing a health behavior intervention in a community-based setting. TRIUMPH provides a model for incorporating the translational science research paradigm to conducting pragmatic behavioral trials in a real-world setting in a vulnerable population. Lessons learned through interactions with our community partners reinforce the value of community engagement in research.
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Affiliation(s)
- Carla Boutin-Foster
- Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
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31
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Peterson JC. The adaptive neuroplasticity hypothesis of behavioral maintenance. Neural Plast 2012; 2012:516364. [PMID: 23125937 PMCID: PMC3480013 DOI: 10.1155/2012/516364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/23/2012] [Accepted: 08/26/2012] [Indexed: 12/20/2022] Open
Abstract
Physical activity is a seemingly simple and clinically potent method to decrease morbidity and mortality in people with coronary heart disease (CHD). Nonetheless, long-term maintenance of physical activity remains a frustratingly elusive goal for patients and practitioners alike. In this paper, we posit that among older adults with CHD, recidivism after the initiation of physical activity reflects maladaptive neuroplasticity of malleable neural networks, and people will revert back to learned and habitual physical inactivity patterns, particularly in the setting of stress or depression. We hypothesize that behavioral interventions that successfully promote physical activity may also enhance adaptive neuroplasticity and play a key role in the maintenance of physical activity through the development of new neuronal pathways that enhance functional ability in older adults. Conversely, without such adaptive neuroplastic changes, ingrained maladaptive neuroplasticity will prevail and long-term maintenance of physical activity will fail. In this paper we will: (1) describe the enormous potential for neuroplasticity in older adults; (2) review stress and depression as examples of maladaptive neuroplasticity; (3) describe an example of adaptive neuroplasticity achieved with a behavioral intervention that induced positive affect in people with CHD; and (4) discuss implications for future work in bench to bedside translational research.
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Affiliation(s)
- Janey C Peterson
- Weill Cornell Medical College, Center for Integrative Medicine and the Division of Clinical Epidemiology and Evaluative Sciences Research, New York, NY 10065, USA.
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