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Walsh CA, Miller SJ, Smith CB, Prigerson HG, McFarland D, Yarborough S, Santos CDL, Thomas R, Czaja SJ, RoyChoudhury A, Chapman-Davis E, Lachs M, Shen MJ. Acceptability and usability of the Planning Advance Care Together (PACT) website for improving patients' engagement in advance care planning. PEC INNOVATION 2024; 4:100245. [PMID: 38145252 PMCID: PMC10733677 DOI: 10.1016/j.pecinn.2023.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
Objectives Most prior advance care planning (ACP) interventions lack integration of the social context of patients' ACP process, which patients indicate is critically important. The current study developed the Planning Advance Care Together (PACT) website to foster inclusion of loved ones in the ACP process. Methods To provide feedback about the PACT website, patients with advanced cancer (N = 11), their caregivers (N = 11), and experts (N = 10) participated in semi-structured interviews. Patients and caregivers also completed standardized ratings of acceptability and usability. Results Overall, patient (n = 11) and caregiver (n = 11) ratings of acceptability and usability of the website exceeded benchmark cut-offs (≥24 on the Acceptability E-Scale and ≥ 68 on the System Usability Scale). Patients, caregivers, and experts liked the topic of ACP but felt that it could be emotionally challenging. They recommended focusing more on planning and less on end of life. They appreciated being able to include loved ones and recommended adding resources for caregivers. Conclusions Study findings support the preliminary usability and acceptability of the PACT website. Findings will be used to inform a modified prototype of the PACT website that is interactive and ready for field testing with patients with advanced cancer and their loved ones. Innovation We utilized a novel application of the shared mind framework to support patients with advanced cancer in engaging their loved ones in the ACP process.
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Affiliation(s)
- Casey A. Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Sarah J. Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Cardinale B. Smith
- Division of Hematology and Medical Oncology, Division of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Holly G. Prigerson
- Department of Medicine, Cornell Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, NY, United States of America
| | - Daniel McFarland
- Department of Psychiatry, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Sarah Yarborough
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Claudia De Los Santos
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Robert Thomas
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sara J. Czaja
- Division of Geriatrics and Palliative Medicine, Center on Aging and Behavioral Research, Weill Cornell Medicine, New York, NY, United States of America
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Eloise Chapman-Davis
- Division of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Mark Lachs
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
- Geriatrics and Palliative Medicine, New York Presbyterian Health Care System, United States of America
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
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Fleszar-Pavlović SE, Cameron LD. Developing a narrative communication intervention in the context of HPV vaccination. PEC INNOVATION 2024; 4:100272. [PMID: 38525313 PMCID: PMC10957452 DOI: 10.1016/j.pecinn.2024.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
Objective We outline the development of a narrative intervention guided by the Common-Sense Model of Self-Regulation (CSM) to promote Human Papillomavirus (HPV) vaccination in a diverse college population. Methods We adapted the Obesity-Related Behavioral Intervention Trials (ORBIT) model to guide the development, evaluation, and refinement of a CSM-guided narrative video. First, content experts developed a video script containing information on HPV, HPV vaccines, and HPV-related cancers. The script and video contents were evaluated and refined, in succession, utilizing the think-aloud method, open-ended questions, and a brief survey during one-on-one interviews with university students. Results Script and video content analyses led to significant revisions that enhanced quality, informativeness, and relevance to the participants. We highlight the critical issues that were revealed and revised in the iterative process. Conclusions We developed and refined a CSM guided narrative video for diverse university students. This framework serves as a guide for developing health communication interventions for other populations and health behaviors. Innovation This project is the first to apply the ORBIT framework to HPV vaccination and describe a process to develop, evaluate, and refine comparable CSM guided narrative interventions that are tailored to specific audiences.
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Affiliation(s)
- Sara E. Fleszar-Pavlović
- Department of Psychological Sciences, University of California, Merced, CA, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States of America
| | - Linda D. Cameron
- Department of Psychological Sciences, University of California, Merced, CA, United States of America
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Phillips LA, More KR, Russell D, Kim HS. Evaluating the impact of individuals' morningness-eveningness on the effectiveness of a habit-formation intervention for a simple and a complex behavior. J Behav Med 2024; 47:804-818. [PMID: 39014034 DOI: 10.1007/s10865-024-00503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/30/2024] [Indexed: 07/18/2024]
Abstract
Planning-based interventions are often used to help individuals form habits. Existing literature suggests a one-size-fits all approach to habit formation, but planning interventions may be optimized if tailored to individual differences and/or behavioral complexity. We test the hypothesis that planning to do a relatively complex behaviour (exercise) at a time that matches an individuals' diurnal preference will facilitate behavioral engagement; whereas for a simpler behaviour (calcium supplementation), the optimal time-of-day for a new behavior will occur in the morning. Young, women volunteers (N = 317) were randomly assigned to take calcium supplements or to exercise for 4 weeks and to control (no planning) or to one of three planning interventions (morning plan; evening plan; unassigned-time plan). Participants reported diurnal preference at baseline and habit strength and behavioral frequency weekly. Fitbit Zips and Medication Event Monitoring System Caps (MEMS) were used to objectively assess behavioral engagement. Multilevel modelling found that calcium-supplementation was greatest for morning-types in the morning-cue condition, whereas exercise was greatest for morning-types with morning cues and evening-types with evening cues. Habit-formation strategies may depend on diurnal preference and behavioral complexity. Future research can evaluate the role of other individual differences.
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Affiliation(s)
| | | | - Daniel Russell
- Department of Human Development and Family Studies, Iowa State University, Ames, USA
| | - Hyun Seon Kim
- Department of Psychology, Iowa State University, Ames, USA
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Caru M, Dandekar S, Gordon B, Conroy DE, Barb ED, Doerksen SE, Smink GM, McKeone DJ, Shah NB, Greiner RJ, Schramm JW, Rao P, McGregor L, Schmitz KH. Implementing a behavioral physical activity program in children and adolescent survivors of childhood cancer: a pilot randomized controlled trial. J Behav Med 2024; 47:792-803. [PMID: 38735024 DOI: 10.1007/s10865-024-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
Purpose We aimed to document the acceptability (enrollment rate) and feasibility (phone call delivery rate) of implementing a behavioral PA intervention over 12 weeks, in addition to documenting its effects on patient-reported outcomes and physical functioning. This study also describes the costs of carrying out a behavioral PA intervention. A total of 40 participants were randomized in a 1:1 ratio. The tailored behavioral PA intervention was developed based on the most recent PA guidelines in pediatric oncology and on the COM-B framework to enact PA behavior changes. The prescription (frequency, intensity, time and type (FITT)) was adjusted each week during the weekly support calls. The control group did not receive the intervention. 26 males and 14 females (13.6 years old on average and 2.9 years post-cancer treatment on average) participated in our study. The acceptability rate was 90.9% and the feasibility rate was > 85%. We found that 85% improved PA frequency, 80% improved PA intensity, 100% improved PA time, and 50.0% achieved the recommended PA guidelines. No adverse events were reported over the duration of the intervention. Physical function improved with longer 6-minute walk distances in the intervention group (465.8 ± 74.5 m) than in the control group (398.7 ± 92.9 m) (p = 0.016). PROs scores for all participants were within the limits of the normal range. The estimated cost per participant of carrying out this intervention was USD $126.57. Our 12-week behavioral PA intervention, based on the COM-B framework, was found to be acceptable, feasible and safe in childhood cancer survivors. This study is an important step in the right direction to make exercise standard practice in pediatric oncology.
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Affiliation(s)
- Maxime Caru
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA.
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA.
| | - Smita Dandekar
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Brett Gordon
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - David E Conroy
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Emily D Barb
- School of Kinesiology, Pennsylvania State University-Harrisburg, Middletown, PA, USA
| | - Shawna E Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gayle M Smink
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Daniel J McKeone
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Nidhi B Shah
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Robert J Greiner
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Joseph W Schramm
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Pooja Rao
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Lisa McGregor
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Kathryn H Schmitz
- School of Kinesiology, Pennsylvania State University-Harrisburg, Middletown, PA, USA
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Sui W, Hollman H, Magel E, Rhodes RE. Increasing physical activity among adults affected by COVID-19 social distancing restrictions: A feasibility trial of an online intervention. J Behav Med 2024; 47:886-899. [PMID: 39068263 DOI: 10.1007/s10865-024-00501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/21/2022] [Indexed: 07/30/2024]
Abstract
In response to COVID-19 social distancing restrictions, digitally delivered health interventions present as a potential solution for maintaining or improving individuals' physical activity. This study explored the feasibility of a web-based intervention, informed by the multi-process action control (M-PAC) framework to promote PA among individuals affected by social distancing. Fifty adults self-reporting as insufficiently active were randomized to a 6-week web-intervention (n = 27) or wait-list control (n = 23). Primary feasibility outcomes included recruitment and retention rates and usability and satisfaction scores; secondary outcomes of MVPA and M-PAC constructs and tertiary outcomes of mental health and wellbeing were also assessed. Overall, feasibility of the intervention was high, with a 96% recruitment rate, 84% retention rate, high satisfaction and usability scores, and comparable website usage to similar eHealth interventions. Intervention participants trended towards improved MVPA and M-PAC constructs and outcomes of mental health and wellbeing. Findings suggest study extension to a full-scale RCT.
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Affiliation(s)
- Wuyou Sui
- Behavioural Medicine Lab, Department of Exercise Science, Physical & Health Education, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Heather Hollman
- Behavioural Medicine Lab, Department of Exercise Science, Physical & Health Education, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Emily Magel
- Behavioural Medicine Lab, Department of Exercise Science, Physical & Health Education, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Ryan E Rhodes
- Behavioural Medicine Lab, Department of Exercise Science, Physical & Health Education, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
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Harden SM, Brow K, Zoellner J, Armbruster SD. Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis. Transl Behav Med 2024; 14:527-536. [PMID: 38907663 PMCID: PMC11370635 DOI: 10.1093/tbm/ibae030] [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: 06/24/2024] Open
Abstract
Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katie Brow
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jamie Zoellner
- Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Shannon D Armbruster
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA, USA
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Pozzar RA, Enzinger AC, Howard C, Tavormina A, Matulonis UA, Campos S, Liu JF, Horowitz N, Konstantinopoulos PA, Krasner C, Wall JA, Sciacca K, Meyer LA, Lindvall C, Wright AA. Feasibility and acceptability of a nurse-led telehealth intervention (BOLSTER) to support patients with peritoneal carcinomatosis and their caregivers: A pilot randomized clinical trial. Gynecol Oncol 2024; 188:1-7. [PMID: 38851039 PMCID: PMC11368606 DOI: 10.1016/j.ygyno.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Patients with advanced gynecologic (GYN) and gastrointestinal (GI) cancers frequently develop peritoneal carcinomatosis (PC), which limits prognosis and diminishes health-related quality of life (HRQoL). Palliative procedures may improve PC symptoms, yet patients and caregivers report feeling unprepared to manage ostomies, catheters, and other complex needs. Our objectives were to (1) assess the feasibility of an efficacy trial of a nurse-led telehealth intervention (BOLSTER) for patients with PC and their caregivers; and (2) assess BOLSTER's acceptability, potential to improve patients' HRQoL and self-efficacy, and potential impact on advance care planning (ACP). METHODS Pilot feasibility RCT. Recently hospitalized adults with advanced GYN and GI cancers, PC, and a new complex care need and their caregivers were randomized 1:1 to BOLSTER or enhanced discharge planning (EDP). We defined feasibility as a ≥ 50% approach-to-consent ratio and acceptability as ≥70% satisfaction with BOLSTER. We assessed patients' HRQoL and self-efficacy at baseline and six weeks, then compared the proportion experiencing meaningful improvements by arm. ACP documentation was identified using natural language processing. RESULTS We consented 77% of approached patients. In the BOLSTER arm, 91.0% of patients and 100.0% of caregivers were satisfied. Compared to EDP, more patients receiving BOLSTER experienced improvements in HRQoL (68.4% vs. 40.0%) and self-efficacy for managing symptoms (78.9% vs. 35.0%) and treatment (52.9% vs. 42.9%). The BOLSTER arm had more ACP documentation. CONCLUSIONS BOLSTER is a feasible and acceptable intervention with the potential to improve patients' HRQoL and promote ACP. An efficacy trial comparing BOLSTER to usual care is underway. TRIAL REGISTRATION ClinicalTrials.gov: NCT03367247; PI: Wright.
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Affiliation(s)
- Rachel A Pozzar
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Andrea C Enzinger
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | | | - Ursula A Matulonis
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Susana Campos
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joyce F Liu
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Neil Horowitz
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Carolyn Krasner
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jaclyn A Wall
- University of Alabama, Birmingham, AL, United States
| | - Kate Sciacca
- Dana Farber Cancer Institute, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Larissa A Meyer
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Charlotta Lindvall
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Alexi A Wright
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Ibrahim AH, Beaumont CT, Strohacker K. Exploring Regular Exercisers' Experiences with Readiness/Recovery Scores Produced by Wearable Devices: A Descriptive Qualitative Study. Appl Psychophysiol Biofeedback 2024; 49:395-405. [PMID: 38668986 DOI: 10.1007/s10484-024-09645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 08/09/2024]
Abstract
Meta-session autoregulation, a person-adaptive exercise programming approach, is characterized by individuals' matching exercise demands specifically to their current readiness states. Some consumer wearables provide 'recovery' or 'readiness' scores, computed primarily based on heart rate variability. Despite the growing popularity of consumer wearables and interest in person-adaptive programming, limited research exists on how exercisers interact, interpret and use these scores. This study explores individuals' experiences with wearable devices and their associated readiness or recovery scores. Seventeen regular exercisers who owned and used a Whoop™ band or Oura™ ring for at least 3 months participated in a one-on-one virtual semi-structured interview. Interviews were analyzed using reflexive thematic analysis, with themes supported by 'in-vivo' quotes. This paper focuses on three key themes for a comprehensive demonstration. Theme 1, 'It's more about how I can make adjustments to optimize my programming,' (MPR) highlights users' intended use of wearables for guiding training decisions. Theme 2, 'So many things outside of training modifications have changed,' (Misty) reveals that users also modify non-exercise behaviors to manage and optimize their scores. Theme 3, 'You can't really capture the complexities of a human on a device' (Letty) underscores users' recognition of the limitations and errors associated with these devices emphasizing self-reliance to further direct behavioral adjustments. While wearable devices provide a numeric approach to measuring readiness and recovery, users prioritize self-awareness, flexibility, and personal judgment for exercise decisions. Understanding these experiences, in addition to exploring the psycho-behavioral aspects of user interactions, can contribute to refining meta-session autoregulation.
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Affiliation(s)
- Adam H Ibrahim
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 1914 Andy Holt Avenue Health and Physical Education Recreation Building 314, Knoxville, TN, 37996-2700, USA.
| | - Cory T Beaumont
- Department of Allied Health, Sport, and Wellness, Baldwin Wallace University, Berea, OH, USA
| | - Kelley Strohacker
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 1914 Andy Holt Avenue Health and Physical Education Recreation Building 314, Knoxville, TN, 37996-2700, USA
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Campos BA, Cummins E, Sonnay Y, Brindle ME, Cauley CE. A Digital Communication Intervention to Support Older Adults and Their Care Partners Transitioning Home After Major Surgery: Protocol for a Qualitative Research Study. JMIR Res Protoc 2024; 13:e59067. [PMID: 39196629 DOI: 10.2196/59067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Older adults (aged ≥65 years) account for approximately 30% of inpatient procedures in the United States. After major surgery, they are at high risk of a slow return to their previous functional status, loss of independence, and complications like delirium. With the development and refinement of Enhanced Recovery After Surgery protocols, older patients often return home much earlier than historically anticipated. This put a larger burden on care partners, close family or friends who partner with the patient and guide them through recovery. Without adequate preparation, both patients and their care partners may experience poor long-term outcomes. OBJECTIVE This study aimed to improve and streamline recovery for patients aged ≥65 years by exploring the communication needs of patients and their care partners. Information from this study will be used to inform an intervention developed to address these needs and define processes for its implementation across surgical clinics. METHODS This qualitative research protocol has two aims. First, we will define patient and care partner needs and perspectives related to digital health innovation. To achieve this aim, we will recruit dyads of patients (aged ≥65 years) who underwent elective major surgery 30-90 days prior and their respective care partners (aged ≥18 years). Participants will complete individual interviews and surveys to obtain demographic data, characterize their perceptions of the surgical experience, identify intervention targets, and assess for the type of intervention modality that would be most useful. Next, we will explore clinician perspectives, tools, and strategies to develop a blueprint for a digital intervention. To achieve this aim, clinicians (eg, geriatricians, surgeons, and nurses) will be recruited for focus groups to identify current obstacles affecting surgical outcomes for older patients, and we will review current assessments and tools used in their clinical practice. A hybrid deductive-inductive approach will be undertaken to identify relevant themes. Insights from both clinicians and patient-care partners will guide the development of a digital intervention strategy to support older patients and their care partners after surgery. RESULTS This study has been approved by the Massachusetts General Hospital and Harvard Institutional Review Boards. Recruitment began in December 2023 for the patient and care partner interviews. As of August 2024, over half of the interviews have been performed, deidentified, and transcribed. Clinician recruitment is ongoing, with no focus groups conducted yet. The study is expected to be completed by fall 2024. CONCLUSIONS This study will help create a scalable digital health option for older patients undergoing major surgery and their care partners. We aim to enhance our understanding of patient recovery needs; improve communication with surgical teams; and ultimately, reduce the overall burden on patients, their care partners, and health care providers through real-time assessment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59067.
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Affiliation(s)
- Brian A Campos
- Ariadne Labs, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emily Cummins
- Ariadne Labs, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Yves Sonnay
- Ariadne Labs, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Mary E Brindle
- Ariadne Labs, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Pediatric Surgery, University of Calgary, Calgary, AB, Canada
| | - Christy E Cauley
- Ariadne Labs, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
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Poulter MML, Balsom AA, Gordon JL. Pilot trial of a new self-directed psychological intervention for infertility-related distress. Pilot Feasibility Stud 2024; 10:111. [PMID: 39152484 PMCID: PMC11328509 DOI: 10.1186/s40814-024-01535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Now affecting one in six couples in Canada, infertility is defined as a lack of conception after 12 or more months of regular, unprotected heterosexual intercourse. Infertility is associated with immense psychological burden, particularly for individuals assigned female at birth. Yet existing psychological interventions are not specialized to this population and have been shown to be only marginally effective at relieving distress related to infertility. Thus, a new online self-directed psychological intervention was co-created with a panel of women experiencing infertility, and ultimately consisted of six 10-min video modules addressing the cognitive, emotional, and interpersonal aspects of infertility-related distress. METHODS In the current study, 21 women experiencing reduced quality of life related to infertility were recruited to participate in a one-arm pre-post pilot testing the feasibility, acceptability, and preliminary efficacy of the program. Participant adherence and retention were monitored, and participants rated the credibility of the program and the helpfulness of each module as well as provided feedback on the content and format of the program. Pre-to-post changes in fertility quality of life, anxious symptoms, depressive symptoms, and relationship satisfaction were examined. RESULTS The program modules were highly rated by participants, with average helpfulness ratings ranging from 7.5 to 8.2/10. Two participants became pregnant and therefore stopped prematurely, 79% of the remaining participants completed all six modules, and participants reported completing 52.8 (SD = 82.0) min of homework per week. Participants perceived the intervention as highly credible and generally approved of the format, length, and speed; however, 68% of participants had recommendations for additional content to be included in the intervention. While relationship satisfaction did not change significantly over time, large pre-to-post improvements in fertility quality of life, depression, and anxiety were observed (p < .001; Cohen's ds = 0.9-1.3). CONCLUSIONS This self-directed intervention was well received and has the potential to be highly effective in reducing infertility-related distress, informing future development and optimization. TRIAL REGISTRATION ClinicalTrials.gov, NCT05103982.
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Affiliation(s)
| | - Ashley A Balsom
- Department of Psychology, University of Regina, Regina, SK, Canada
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11
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Mancinelli E, Magnolini S, Gabrielli S, Salcuni S. A Chatbot (Juno) Prototype to Deploy a Behavioral Activation Intervention to Pregnant Women: Qualitative Evaluation Using a Multiple Case Study. JMIR Form Res 2024; 8:e58653. [PMID: 39140593 PMCID: PMC11358662 DOI: 10.2196/58653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/14/2024] [Accepted: 06/17/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Despite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. OBJECTIVE Building from a previous co-design study, this study aimed to qualitatively evaluate pregnant women's experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. METHODS Using a multiple-case study design, the research aims to uncover similarities and differences in participants' perceptions of the chatbot while also exploring women's desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. RESULTS Similarities and differences have emerged regarding women's experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot's limitations. CONCLUSIONS Overall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring.
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Affiliation(s)
- Elisa Mancinelli
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
- Digital Health Lab, Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Povo, Trento, Italy
| | - Simone Magnolini
- Intelligent Digital Agents, Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Povo, Trento, Italy
| | - Silvia Gabrielli
- Digital Health Lab, Centre for Digital Health and Wellbeing, Fondazione Bruno Kessler, Povo, Trento, Italy
| | - Silvia Salcuni
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
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12
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Robertson MC, Swartz MC, Basen-Engquist KM, Li Y, Jennings K, Thompson D, Baranowski T, Volpi E, Lyons EJ. A social media game to increase physical activity among older adult women: protocol of a randomized controlled trial to evaluate CHALLENGE. BMC Public Health 2024; 24:2172. [PMID: 39135010 PMCID: PMC11318238 DOI: 10.1186/s12889-024-19662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count. METHODS We will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews. DISCUSSION By taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition Sciences and Health Behavior, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Maria Chang Swartz
- Department of Pediatrics, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen M Basen-Engquist
- Department of Health Disparities, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debbe Thompson
- US Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Tom Baranowski
- US Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Elena Volpi
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Elizabeth J Lyons
- Department of Nutrition Sciences and Health Behavior, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA.
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Tighe CA, Phares A, Weiner DK, Beehler GP, VanSwearingen J, Harvey AG, Hilgeman MM, Buysse DJ, Forman DE. Adapting and Evaluating the Feasibility and Acceptability of a Behavioral Intervention to Promote Sleep Health in Cardiac Rehabilitation. Behav Sleep Med 2024:1-16. [PMID: 39120442 DOI: 10.1080/15402002.2024.2386602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
OBJECTIVES Study objectives were to: 1) iteratively adapt the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for patients in cardiac rehabilitation (CR; Phase 1) and 2) conduct a preliminary single group pre-post intervention test to a) evaluate procedural feasibility and intervention acceptability and b) to explore preliminary pre-post changes in self-reported sleep, disability, and health-related quality of life (HRQoL; Phase 2). METHOD In Phase 1, 12 individuals in CR and six content experts completed interviews to inform TranS-C adaptations. Interviews were analyzed using rapid qualitative analysis. In Phase 2, eight individuals in CR completed a baseline assessment, the adapted TranS-C intervention, and a post-intervention assessment. Intervention acceptability was assessed via questionnaire and interview. Sleep, disability, and HRQoL outcomes were assessed using questionnaires. Descriptive statistics were calculated for quantitative measures; interviews were analyzed using rapid qualitative analysis. RESULTS Phase 1 participants were receptive to the premise and structure of the adapted intervention. In Phase 2, participants endorsed positive attitudes toward the intervention. Seven of eight participants demonstrated improvements in sleep outcomes. Disability and HRQoL results did not consistently improve. CONCLUSION The adapted TranS-C intervention was acceptable to CR patients and could yield improvements in subjective sleep outcomes. Larger-scale testing in CR is warranted.
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Affiliation(s)
- Caitlan A Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychology, Providence College, Providence, RI, USA
| | - Angela Phares
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gregory P Beehler
- Center for Integrated Healthcare, VA Center for Integrated Healthcare, Buffalo, NY, USA
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA
| | - Jessie VanSwearingen
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison G Harvey
- Psychology Department, University of California Berkeley, Berkeley, CA, USA
| | - Michelle M Hilgeman
- Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- Department of Medicine, Division of Gerontology, Geriatrics, & Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology and Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Daniel J Buysse
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel E Forman
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kroshus-Havril E, Kesner T, Steiner MK, Senturia K, Rivara FP. Development and Evaluation of a Web-Based Family-Centered Decision Support Tool About Firearm Storage. Ann Behav Med 2024; 58:610-618. [PMID: 39022991 DOI: 10.1093/abm/kaae039] [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: 07/20/2024] Open
Abstract
BACKGROUND Many youth in the USA have access to a loaded and unlocked firearm in their home. Discussions between adult family members have the potential to positively influence firearm storage. PURPOSE Work with firearm-owning parents to develop and obtain preliminary data about the efficacy of a family-centered decision support tool about firearm storage. METHODS We adapted the Ottawa Personal Decision Guide for Two to the issue of firearm storage, producing the Family Safety Check-In. Subsequently, we evaluated its acceptability and impact on intentions to make a plan with their partner (or other adult sharing parental duties) about safer firearm storage. Participants were parents/guardians of at least one school-aged child, had firearms in their home, and resided in the USA (n = 402). They completed a web-based pre-test survey, were randomized to the Family Safety Check-In or an American Academy of Pediatrics (AAP) informational resource about firearm storage for families, and then completed a post-test survey. RESULTS The Family Safety Check-In had higher ratings for acceptability (B = 1.24, 95% CI = 0.58-1.90) and appropriateness (B = 1.46, 95% CI = 0.72-2.19) than the AAP resource. Participants in the Family Safety Check-In condition also had greater intentions to make a plan with their partner about storing firearms more safely (OR = 1.90, 95% CI = 1.26-2.87). CONCLUSIONS The Family Safety Check-In is a promising direction for harm reduction that warrants further evaluation.
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Affiliation(s)
- Emily Kroshus-Havril
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Todd Kesner
- University of Arizona Extension, 4-H State Office, University of Arizona, Tucson AZ, USA
| | - Mary Kathleen Steiner
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kirsten Senturia
- University of Washington, School of Public Health, Seattle WA, USA
| | - Frederick P Rivara
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- The Firearm Injury & Policy Research Program, University of Washington, Department of Pediatrics, Seattle WA, USA
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15
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Fong AJ, Llanos AAM, Hudson SV, Schmitz K, Lu SE, Phillips SM, Manne SL. Online-delivered resistance exercise intervention among racially diverse breast cancer survivors: Feasibility, acceptability, and exploratory outcomes of B-REP. Support Care Cancer 2024; 32:565. [PMID: 39090218 DOI: 10.1007/s00520-024-08769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The aims are to determine the feasibility of an online-delivered resistance exercise program among racially diverse breast cancer survivors and to conduct an exploratory analysis of the intervention on muscular strength, physical activity levels, health-related quality of life, and self-efficacy. METHODS A 2-arm randomized controlled trial study design with assessments at pre- and post-intervention was used. Participants (n = 52) were recruited from clinics at the host institution and randomized to either intervention (n = 28) or minimal contact control (MCC) conditions (n = 24). All participants received a 12-week individualized resistance exercise prescription based on their baseline functional strength assessment. Intervention participants exercised one-on-one once per week over Zoom with an exercise trainer. MCC participants received no supervision. Descriptive statistics were used to determine feasibility and acceptability (primary outcomes). Repeated measures ANOVAs were used to examine exploratory outcomes. RESULTS The intervention demonstrated high rates for feasibility outcomes of enrollment (80.0%) and post-intervention assessment completion (92.9%). Acceptability outcomes were high for session attendance (98.0%) and satisfaction (Mscore = 4.87 out of 5, SD = .18). The intervention group increased upper- (p < .01) and lower- (p < .02) body strength compared to MCC condition. CONCLUSIONS The intervention was feasible, acceptable, and demonstrated increases in muscular strength. Limitations include a small sample recruited from one cancer center. Future research is needed to determine longitudinal impacts of resistance exercise on survivorship outcomes. Online-delivered resistance exercise shows promising efficacy among racially diverse breast cancer survivors. CLINICALTRIALS gov registration: NCT04562233 on September 18, 2020.
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Affiliation(s)
- Angela J Fong
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
| | - Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Johnson Medical School, Rutgers Robert Wood, New Brunswick, NJ, USA
| | - Kathryn Schmitz
- Division of Hematology/Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | - Shou-En Lu
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharon L Manne
- Section of Behavioral Sciences, Rutgers Cancer Institute, New Brunswick, NJ, USA
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16
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Buron L, Desjardins L. Commentary: Intervention research in pediatric rare diseases. J Pediatr Psychol 2024; 49:536-537. [PMID: 38872282 DOI: 10.1093/jpepsy/jsae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Laurianne Buron
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine's University Health Center, Montreal, Quebec, Canada
| | - Leandra Desjardins
- Sainte-Justine's University Health Center, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
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17
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Arch JJ, Slivjak ET, Finkelstein LB. A Novel Intervention to Reduce Fear of Progression and Trauma Symptoms in Advanced Cancer Using Written Exposure to Worst-Case Scenarios. J Palliat Med 2024; 27:1009-1017. [PMID: 38579139 DOI: 10.1089/jpm.2023.0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Background: Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. Objective: To develop and pilot a written exposure-based coping intervention (EASE) focused on worst-case scenarios among adults with advanced cancer reporting elevated cancer-related trauma symptoms or FoP. Design: A single-arm intervention development and pilot trial. Participants: The trial enrolled 29 U.S. adults with stage III or stage IV solid tumor cancer (n = 24) or incurable or higher-risk blood cancer (n = 5) reporting elevated cancer-related trauma symptoms or FoP. Among those screened, 74% were eligible, with an eligible-to-enrolled rate of 85%. Design/Measurements: EASE was delivered over five 1:1 videoconferencing sessions. Feasibility and acceptability were evaluated via attendance, surveys, and exit interviews. Outcomes were assessed at five time points through 3-month (FU1, main assessment of interest) and 4.5-month (FU2) follow-up. Results: Participant and interventionist feedback was used to iteratively refine EASE. Among participants, 86% (25/29) completed all five sessions and FU1; surveys and exit interviews indicated high acceptability. Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes. Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue, and most process measures improved significantly by FU1 or FU2. Conclusions: EASE, a novel adaptation of written exposure therapy, is a promising approach to reducing FoP and cancer-related trauma symptoms among adults with advanced cancer that warrants further study.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Lauren B Finkelstein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Asiimwe SB, Kekibiina A, Woolf-King SE, Fatch R, Emenyonu N, Hahn JA. Alcohol Consumption Among Persons Living with HIV: Perceptions, Messages and Interventions-A Qualitative Study at an HIV Treatment Clinic in South Western Uganda. AIDS Behav 2024; 28:2559-2576. [PMID: 38839725 DOI: 10.1007/s10461-024-04377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
In Sub-Saharan Africa, efficacy trials of brief interventions to reduce unhealthy drinking among persons living with HIV (PLWH) have yielded mixed results. A better understanding of the perceptions of drinking, especially by PLWH, and how drinking is talked about at HIV treatment clinics in this setting, may guide more optimal designs for future trials. We conducted a qualitative study at an HIV treatment clinic in South Western Uganda to better understand perceptions of drinking, how drinking is talked about, and perceptions of interventions, especially a protocolled screening and brief intervention (SBI) for unhealthy drinking among PLWH. We conducted in-depth interviews with 17 PLWH who engaged in unhealthy drinking and 6 health workers, and one focus group discussion with 3 community advisory-board members. We performed manual preliminary data analysis and computer-assisted detailed thematic analysis to identify emergent themes. Four themes emerged: perceptions of alcohol use in the general population; perceptions of alcohol use in PLWH; interaction between PLWH and health workers about alcohol use; perceptions of interventions for unhealthy drinking including SBI. Unhealthy drinking was seen as a problem in the general population and among those with HIV, where it was negatively perceived. Communication about drinking was done by counselors, but doctors participated in screening for unhealthy alcohol use. Messages about drinking covered reduction and abstinence. Participants expressed positive attitudes towards SBI and preference for person-delivered SBI over technological alternatives. A protocolled SBI for unhealthy alcohol use among PLWH would be well-received but successful implementation may depend on mode of delivery.
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Affiliation(s)
- Stephen B Asiimwe
- Uganda AIDS Commission, Plot 1-3 Salim Bay Road, Ntinda, P.O Box 10779, Kampala, Uganda.
| | - Allen Kekibiina
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Robin Fatch
- University of California San Francisco, San Francisco, CA, USA
| | - Nneka Emenyonu
- University of California San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- University of California San Francisco, San Francisco, CA, USA
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Lee K, Bauman A, Wolfenden L, Phongsavan P, Crane M. How long does it take to scale-up obesity prevention interventions? Prev Med 2024; 185:108012. [PMID: 38821419 DOI: 10.1016/j.ypmed.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/06/2024] [Accepted: 05/25/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The scale-up of evidence-based interventions is necessary to reverse high rates of obesity. However, scale-up doesn't occur frequently nor in a timely manner. While it has been estimated that takes 14-17 years for research translation to occur, the time taken to scale-up prevention interventions is largely unknown. This study examined the time taken to scale-up obesity prevention interventions across four scale-up pathways. METHODS A sample of obesity prevention interventions that had been scaled-up or implemented at scale were found using a structured search strategy. Included interventions were mapped against four scale-up pathways and timeframes associated with each stage of the scale-up pathway were identified to determine the time taken to scale-up. RESULTS Of the 90 interventions found that were scaled-up to at least a city-wide level, less than half reported a comprehensive research pathway to scale-up and a third did not report any evidence of efficacy or effectiveness prior to scale-up. The time taken to scale-up ranged from 0 to 5 years depending on the pathway taken. Those following a comprehensive pathway took approximately 5 years to scale-up, while interventions that had only one evidence generating step took between 1 and 1.5 years to scale-up. For the remaining interventions, scale-up occurred immediately post-development without evidence generation. CONCLUSIONS Our findings indicate that the scale-up of obesity prevention interventions can occur more quickly than previous estimates of 14-17 years. Our findings support previous research that scale-up of interventions occurs through a variety of pathways and often scale-up occurs in absence of prior evidence of effectiveness.
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Affiliation(s)
- Karen Lee
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
| | - Adrian Bauman
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
| | - Luke Wolfenden
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia; The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Philayrath Phongsavan
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Melanie Crane
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
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20
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Kepper MM, Fowler LA, Kusters IS, Davis JW, Baqer M, Sagui-Henson S, Xiao Y, Tarfa A, Yi JC, Gibson B, Heron KE, Alberts NM, Burgermaster M, Njie-Carr VP, Klesges LM. Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity. J Med Internet Res 2024; 26:e51355. [PMID: 39088246 PMCID: PMC11327633 DOI: 10.2196/51355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 08/02/2024] Open
Abstract
The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.
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Affiliation(s)
- Maura M Kepper
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Lauren A Fowler
- Sexuality, Health, and Gender Center, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States
| | - Isabelle S Kusters
- Department of Health, Human, and Biomedical Sciences, University of Houston-Clear Lake, Houston, TX, United States
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Manal Baqer
- Neamah Health Consulting, Boston, MA, United States
| | - Sara Sagui-Henson
- Clinical Strategy and Research Team, Modern Health, San Francisco, CA, United States
| | - Yunyu Xiao
- Department of Population Health Science, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Adati Tarfa
- School of Medicine, Yale University, New Haven, CT, United States
| | - Jean C Yi
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kristin E Heron
- Psychology Department, Old Dominion University, Norfolk, VA, United States
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, United States
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Marissa Burgermaster
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, United States
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Veronica Ps Njie-Carr
- Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, MD, United States
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
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Bradley SS, de Holanda LJ, Chau T, Wright FV. Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments. Front Neurosci 2024; 18:1398459. [PMID: 39145294 PMCID: PMC11322617 DOI: 10.3389/fnins.2024.1398459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. Clinical trial registration https://clinicaltrials.gov, identifier NCT05463211.
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Affiliation(s)
- Stefanie S. Bradley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Quilico EL, Wilkinson S, Duncan LR, Sweet SN, Alarie C, Bédard E, Gheta I, Brodeur CL, Colantonio A, Swaine BR. Feasibility and acceptability of an adapted peer-based walking intervention for adults with moderate-to-severe traumatic brain injury. Disabil Rehabil 2024:1-8. [PMID: 39051571 DOI: 10.1080/09638288.2024.2381616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To examine the feasibility and acceptability of a 6-week peer-based walking intervention for adults with moderate-to-severe TBI with telehealth supports. MATERIALS AND METHODS Pre-post feasibility trial with 18 community-dwelling adults (10 men; 8 women) with moderate-to-severe TBI aged 21-61 years (M = 40.6, SD = 11.3). Feasibility outcomes included participation, attrition, safety across 12 90-minute sessions, and telehealth platform quality. Acceptability outcomes included program satisfaction. Exploratory outcomes included daily step count with activity trackers and pre-post intervention questionnaires (mood, leisure satisfaction, exercise self-efficacy, quality of life) through video conferencing. RESULTS 15/18 (83%) participants completed ≥ 9 sessions (75%). Three participants were lost to attrition. No major adverse events reported. Minor events included fatigue and muscle soreness. Participants reported high satisfaction (M = 9.2/10, SD = 0.9). Average weekly steps per day rose from 10,011 to 11,177 steps (12%). Three participants' step count data were not included due to tremors or forgetting to wear the device (≥ 9 days). One major and several minor connectivity problems occurred. Wilcoxon Signed Ranks tests identified a significant change in negative affect (p < 0.002). CONCLUSIONS Findings support the feasibility and acceptability of a 6-week peer-based walking intervention with telehealth supports for our sample.
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Affiliation(s)
- E L Quilico
- Baylor Scott & White Research Institute, Dallas, TX, USA
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- Applied Human Sciences, Concordia University, Montreal, Canada
| | - S Wilkinson
- Applied Human Sciences, Concordia University, Montreal, Canada
| | - L R Duncan
- Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - S N Sweet
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - C Alarie
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- School of Rehabilitation, University of Montreal, Montreal, Canada
| | - E Bédard
- Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - I Gheta
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - C L Brodeur
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - A Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - B R Swaine
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- School of Rehabilitation, University of Montreal, Montreal, Canada
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23
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Steiner JM, Marshall AR, Kovacs AH, Engelberg RA, Brumback L, Stout KK, Longenecker CT, Yi-Frazier JP, Rosenberg AR. Rationale and design of a randomized controlled clinical trial of a resilience-building intervention in adults with congenital heart disease. Contemp Clin Trials 2024; 145:107638. [PMID: 39047811 DOI: 10.1016/j.cct.2024.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are at risk for lower quality of life (QOL) and psychological health. Behavioral interventions to meet their psychosocial needs are lacking. The aim of this study is to evaluate the feasibility of implementing the Promoting Resilience in Stress Management (PRISM) intervention in ACHD and its efficacy in increasing resilience in this population. METHODS We designed a phase II randomized controlled clinical trial of patients with moderate or complex ACHD, physiological stages C or D. Enrolled participants will be randomized to receive PRISM or usual care. PRISM is a manualized, skills-based behavioral intervention comprised of four one-on-one sessions targeting resilience resources (stress-management, goal-setting, cognitive reframing, meaning making), an optional session on advance care planning, and a facilitated family meeting. Participants in both groups will complete study questionnaires at enrollment and 3-months later. The primary aim is to describe feasibility, namely the proportions of patients who a) enroll in the study among those eligible, and b) complete the PRISM intervention among those randomized to that arm. We will also evaluate PRISM's efficacy by using linear regression models to compare changes in mean resilience scores between assigned groups. In exploratory analyses, we will evaluate effects on QOL, psychological distress, perceived competence for health care management, and comfort with advance care planning. DISCUSSION This study will provide rigorous evidence to determine the feasibility and efficacy of a brief intervention to promote resilience and psychosocial health in ACHD. Findings may guide the development of a future multi-site effectiveness study. CLINICAL TRIAL REGISTRATION NCT04738474.
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Affiliation(s)
- Jill M Steiner
- Division of Cardiology, Department of Medicine & Cambia Palliative Care Center of Excellence, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA.
| | - Arisa Rei Marshall
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Adrienne H Kovacs
- Equilibria Psychological Health, 10-255 The East Mall, Toronto, Ontario M9B 0A9, Canada
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine & Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA
| | - Lyndia Brumback
- Department of Biostatistics, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Karen K Stout
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Chris T Longenecker
- Division of Cardiology and Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA 98105, USA
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute & Department of Pediatrics, Harvard Medical School; 450 Brookline Ave, Boston, MA 02215, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute & Department of Pediatrics, Harvard Medical School; 450 Brookline Ave, Boston, MA 02215, USA
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Breiner CE, Miller ML, Hormes JM. ARFID Parent Training Protocol ("ARFID-PTP"): Results of a Randomized Pilot Trial Evaluating a Brief, Parent-Training Program for Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2024. [PMID: 39031449 DOI: 10.1002/eat.24269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP"). METHOD Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up. RESULTS Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (MCEQ-C = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average. DISCUSSION ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04913194.
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Affiliation(s)
- Courtney E Breiner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - McKenzie L Miller
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
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Strohacker K, Sudeck G, Ibrahim AH, Keegan R. Exploring person-specific associations of situational motivation and readiness with leisure-time physical activity effort and experience. PLoS One 2024; 19:e0307369. [PMID: 39024266 PMCID: PMC11257293 DOI: 10.1371/journal.pone.0307369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
Identifying determinants of leisure-time physical activity (LTPA) often relies on population-level (nomothetic) averages, potentially overlooking person-specific (idiographic) associations. This study uses an idiographic perspective to explore how subjective readiness and motives for LTPA relate to volitional effort (duration, intensity) and affective experience (pleasure, displeasure). We also highlight the potential for different interpretations when data are averaged within individuals and assessed using a variable-centered approach. Participants (N = 22, 25±8 years old, 54.5% women) were asked to continue their regular PA patterns for 10 weeks. Ecological momentary assessment procedures allowed participants to provide pre-activity reports (physical, cognitive, emotional readiness and situational motive for activity) and post-activity reports (activity type, duration, perceived exertion, ratings of affective valence). Spearman rank correlation was implemented to interpret within- and between-person associations. Data visualization approaches were used to showcase person-specific differences in associations. Participants provided 519 reports of LTPA (24±11 events/person), which displayed between- and within-person variety in type, duration, intensity, and affective experience. Exemplar cases highlight discrepancies in interpretation based on level of analysis, such that the nomothetic association (rho = .42, p = .05; 95% CI -.02, .72) between motive to replenish energy and LTPA duration was observed in only one within-person analysis (41% were weak-to-large inverse effects). Alternatively, the negligible nomothetic association (rho = .02, p = .93; 95% CI -.41, .44) between physical readiness and LTPA-related affect did not reflect the 59% of within-person analyses showing moderate-to-large, positive effects. Future research aiming to identify determinants of LTPA effort and experience should integrate contemporary, idiographic analyses in early-stage research for developing person-specific strategies for LTPA promotion.
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Affiliation(s)
- Kelley Strohacker
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, United States of America
| | - Gorden Sudeck
- Institute of Sport Science, University Tübingen, Tübingen, Germany
- Interfacultary Research Institute for Sports and Physical Activity, University Tübingen, Tübingen, Germany
| | - Adam H. Ibrahim
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, United States of America
| | - Richard Keegan
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, Australia
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Watkins JM, Goss JM, Major MG, Kwaiser MM, Medellin AM, Hobson JM, Martinez Kercher VM, Kercher KA. Refined Feasibility Testing of an 8-Week Sport and Physical Activity Intervention in a Rural Middle School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:913. [PMID: 39063489 PMCID: PMC11276868 DOI: 10.3390/ijerph21070913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
This study examines how the 8-week Hoosier Sport program impacts cardiovascular disease (CVD) risks by promoting physical activity (PA) among rural, low-income children. Using a human-centered participatory co-design approach, the program aimed to increase PA levels (e.g., total PA, daily steps) in at-risk children. The present study explored the feasibility of the intervention as well as physiological and psychological changes across the intervention using a hybrid type 2 design (a model that evaluates both the effectiveness of an intervention and its implementation in real-world settings). Favorable feasibility indicators like attendance, acceptability, and compliance, with a 23.3% recruitment rate and 94.3% retention rate, were observed. Moreover, participants attended over 80% of sessions across the 8 weeks. Accelerometers (AX3) tracked daily steps and total PA for 7 days before and after the intervention, revealing increased PA levels throughout. At post-intervention, notable improvements were observed in psychological factors such as autonomy, social competence, and global self-worth. This study highlights the importance of tailored PA interventions in schools, emphasizing their potential to improve PA levels among rural, low-income children.
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Affiliation(s)
- Janette M. Watkins
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA; (J.M.W.); (J.M.G.); (M.M.K.)
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Janelle M. Goss
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA; (J.M.W.); (J.M.G.); (M.M.K.)
| | - McKenna G. Major
- School of Medicine, Indiana University, Bloomington, IN 47405, USA;
| | - Megan M. Kwaiser
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA; (J.M.W.); (J.M.G.); (M.M.K.)
| | - Andrew M. Medellin
- Department of Epidemiology & Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA;
| | | | - Vanessa M. Martinez Kercher
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA;
| | - Kyle A. Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA; (J.M.W.); (J.M.G.); (M.M.K.)
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Bamonti PM, Rose GA, Park S, Silberbogen AK, Moye J, Moy ML. Emotional Distress and Physical Activity Engagement in U.S. Veterans With Chronic Obstructive Pulmonary Disease: A Qualitative Study. Ann Behav Med 2024; 58:539-551. [PMID: 38847496 DOI: 10.1093/abm/kaae030] [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: 07/12/2024] Open
Abstract
BACKGROUND Physical activity is recommended as part of guideline-based care for managing chronic obstructive pulmonary disease (COPD) at all stages of the disease. However, physical activity interventions are less effective in individuals with co-occurring emotional distress (i.e., depression and/or anxiety symptoms). Interventions that dually promote improved physical and mental health in COPD are needed. The first step for intervention development is understanding individuals' experience of these factors. PURPOSE To understand the experience of emotional distress in U.S. Veterans diagnosed with COPD and to explore how emotional distress impacts physical activity engagement. METHODS Structured interviews informed by the cognitive and behavioral models of psychopathology were conducted with 29 United States Veterans with COPD (89.66% male, age 67.72 ± 6.55 years, 93.10% White) at the VA Boston Healthcare System. Interviews were audio recorded, transcribed, and underwent thematic analysis. RESULTS Three major themes encapsulating 17 codes emerged through thematic analysis: (i) the experience of emotional distress in Veterans with COPD; (ii) the complex relationship between emotional distress, physical activity engagement, and COPD; (iii) contextual and personal factors. CONCLUSIONS Veterans' interpretation of their COPD symptoms as unpredictable and uncontrollable and COPD-related physical limitations influenced their experience of emotional distress, while the experience of emotional distress both promoted and deterred physical activity engagement. Veterans were motivated to engage in physical activity despite experiencing emotional distress when they faced a responsibility in daily life. They identified motivational strategies and self-regulation techniques to manage emotional distress and to foster physical activity.
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Affiliation(s)
- Patricia M Bamonti
- Research & Development Service, VA Boston Healthcare System, Boston MA, USA
- Department of Psychiatry, Havard Medical School, Boston, MA, USA
| | - Grace A Rose
- Research & Development Service, VA Boston Healthcare System, Boston MA, USA
| | - Stella Park
- New England Geriatric Research Education & Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Amy K Silberbogen
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer Moye
- Department of Psychiatry, Havard Medical School, Boston, MA, USA
- New England Geriatric Research Education & Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Watkins JM, Brunnemer JE, Heeter KN, Medellin AM, Churchill WC, Goss JM, Hobson JM, Werner NE, Weaver RG, Kercher VMM, Kercher KA. Evaluating the feasibility and acceptability of a co-designed physical activity intervention for rural middle schoolers: a pilot study. BMC Public Health 2024; 24:1830. [PMID: 38982408 PMCID: PMC11234612 DOI: 10.1186/s12889-024-19356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Lack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth. METHODS This prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis. RESULTS Key findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the "good" threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport. CONCLUSIONS This study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents.
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Affiliation(s)
- Janette M Watkins
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
| | - Julia E Brunnemer
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Kathleen N Heeter
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Andrew M Medellin
- Department of Epidemiology & Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - William C Churchill
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Janelle M Goss
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Logan University, Chesterfield, MO, USA
| | | | - Nicole E Werner
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vanessa M Martinez Kercher
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Kyle A Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA.
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Kroshus E, Moore A, Steiner MK, Nieto C, McCleery J, Turner K, Garrett K, Tandon PS. Move & Thrive: Development of a Web-Based Training for Schools About Trauma-Informed Physical Activity. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38977391 DOI: 10.1111/josh.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Youth who have experienced trauma or other adverse childhood events have the potential to uniquely benefit from physical activity (PA). However, how PA is administered in schools can be re-traumatizing and fail to create positive experiences through movement. We sought to develop role-specific training to help increase the implementation of trauma-informed PA. METHODS Guided by intervention mapping methodology, we developed "Move & Thrive"-a brief web-based training about trauma-informed PA. We then conducted a pilot evaluation of this training using a pre-posttest design with no control group in a sample of youth sport coaches, parents of school-aged children, and teachers (n = 150) recruited from an online opt-in non-probability panel. RESULTS Mixed methods feedback found that "Move & Thrive" was highly acceptable. Across all roles (coaches, teachers, and parents/guardians) there were statistically significant increases in all targeted implementation determinants (knowledge, attitudes, self-efficacy, and perceived resources/support), with moderate to large effect sizes. CONCLUSIONS These results provide the foundation for a larger, adequately powered trial with randomization and follow-up to assess the implementation of trauma-informed PA.
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Affiliation(s)
- Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Adrienne Moore
- Center for Healing and Justice Through Sport, Seattle, WA
| | - Mary Kathleen Steiner
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
| | - Carolina Nieto
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
| | - Julie McCleery
- Center for Leadership in Athletics, University of Washington, Seattle, WA
| | - Ken Turner
- Washington Office of the Superintendent of Public Instruction, Olympia, WA
| | - Kimberly Garrett
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
| | - Pooja S Tandon
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
- Center for Healing and Justice Through Sport, Seattle, WA
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Shen MJ, Stokes T, Yarborough S, Harrison J. Improving Pain Self-Management Among Rural Older Adults With Cancer. JAMA Netw Open 2024; 7:e2421298. [PMID: 39018074 PMCID: PMC11255907 DOI: 10.1001/jamanetworkopen.2024.21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/10/2024] [Indexed: 07/18/2024] Open
Abstract
Importance Undertreated cancer pain is a major public health concern among older adults in rural communities. Interventions to improve pain management among this vulnerable population are needed. Objective To test the feasibility, acceptability, and changes in pain outcomes from exposure to an adapted intervention, Cancer Health Empowerment for Living without Pain (CA-HELP), to improve patients' communication about pain to their clinicians. Design, Setting, and Participants Older adults with cancer (aged ≥65 years) who were residing in a noninstitutional rural setting and receiving outpatient care at a rural-based clinic in Tennessee were enrolled in the study, in which everyone received the intervention, in May 2022. All patients were given assessments at baseline and 1 week after intervention. Mean score differences were analyzed using 1-tailed paired sample t tests (α = .05). Data were analyzed in June 2022. Exposure The adapted version of CA-HELP included an 18-page patient-facing workbook and a 30-minute telephone coaching call with a registered nurse to coach patients on pain education and communication techniques to discuss pain with their medical team. Main Outcomes and Measures Feasibility was examined through accrual and completion rates. Acceptability was measured by helpfulness, difficulty, and satisfaction with the intervention. Changes in outcomes were measured using mean score differences from pre-post assessments of pain self-management, self-efficacy for communicating with clinicians about pain, patient-reported pain, and misconceptions about pain. Results Among the 30 total participants, the mean (SD) age was 73.0 (5.1) years; 17 participants (56.7%) were female, 5 (16.7%) were Black or African American, 30 (100%) were non-Hispanic or non-Latino, 24 (80.0%) were White, 16 (53.3%) had less than a high school education, and 15 (50.0%) reported income less than $21 000 per year. Based on accrual and completion rates of 100%, this intervention was highly feasible. Fidelity rates for delivering intervention components (100%) and communication competence (27 participants [90%]) were also high. Regarding acceptability, all patients rated the intervention as helpful, with the majority (24 participants [80%]) rating it as "very helpful." Most patients rated the intervention as "not at all difficult" (27 participants [90%]), enjoyed participating (21 participants [70%]), and reported being "very satisfied" (25 participants [83.3%]). Pre-post changes in outcomes suggested significant improvements in pain self-management and self-efficacy for communicating with clinicians about pain, as well as significant reductions in patient-reported pain and pain misconceptions. Conclusions and Relevance In this case-series study of CA-HELP, results suggested the adapted version of CA-HELP was feasible and acceptable and showed changes in pain-related outcome measures among older adults with cancer in a rural setting.
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Affiliation(s)
- Megan J. Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Tammy Stokes
- Maury Regional Medical Center, Columbia, Tennessee
| | - Sarah Yarborough
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
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Meyer JD, Perkins SL, Gidley JM, Kuzniar JM, Phillips LA, Lansing JL, Wade NG, Herring MP, Lefferts WK. Feasibility and preliminary efficacy of a theory-informed resistance exercise training single-arm intervention for major depression. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 73:102642. [PMID: 38615899 DOI: 10.1016/j.psychsport.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/27/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes. PURPOSE To assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow. METHODS Ten adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility. RESULTS Nine participants completed the intervention. Strong feasibility and acceptability (98 % adherence, 93 % compliance, and 90 % retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges' g = 0.84-2.13). There were small-to-moderate increases in MCA velocity (g = 0.32-0.57) and conductance (g = 0.20-0.76) across time, with minimal changes in pulsatility (all g < 0.21). CONCLUSIONS Preliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET's efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.
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Affiliation(s)
- Jacob D Meyer
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA.
| | - Seana L Perkins
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA
| | - John M Gidley
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA
| | | | | | - Jeni L Lansing
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA
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Grant SJ, Liu S, Rhodes RE. A web-based physical activity intervention targeting affect regulation: a randomized feasibility trial. Psychol Health 2024:1-23. [PMID: 38946146 DOI: 10.1080/08870446.2024.2372658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
Early career professionals (ECPs) are a critical target for physical activity (PA) promotion. Affect contributes to an established PA intention-behaviour gap and is pertinent among ECPs. OBJECTIVE The purpose of this study was to examine the feasibility and acceptability of a web-based intervention and explore the effects on secondary outcomes (moderate-to-vigorous PA (MVPA), emotion regulation, multi-process action control constructs). METHODS Adults aged 25-44 who were employed at least part-time in a desk-based job and not meeting PA guidelines (<150 min MVPA) were recruited and randomized into a 6-week online intervention integrating acceptance and commitment principles and affect regulation strategies, or a control group. RESULTS Forty adults were recruited and randomized to the web-based intervention (n = 21) and waitlist control (n = 19). The recruitment rate was 29%, retention was 75%, engagement was 68%, and satisfaction was high in both quantitative and qualitative assessment. Participants allocated to the intervention improved MVPA (ηp2=0.30), emotion regulation (ηp2 =0.49), behavioural regulation (ηp2=0.53), affective attitude (ηp2=0.23), identity (ηp2=0.24), and constructs of mindfulness (ηp2=0.44), and valued living (ηp2=0.20). CONCLUSIONS Primary outcomes concerning feasibility were adequate and secondary outcomes improved, suggesting a full-scale randomized controlled trial is feasible with minor modifications. A large-scale study is warranted to establish intervention effectiveness.
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Affiliation(s)
- Stina J Grant
- Behavioural Medicine Lab, @bmedlab, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- Digital Health Lab, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- Behavioural Medicine Lab, @bmedlab, University of Victoria, Victoria, BC, Canada
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Zheng D, Rose L, Borgundvaag B, McLeod SL, Melady D, Mohindra R, Sinha S, Wesson V, Wiesenfeld L, Kolker S, Kiss A, Lowthian JA, Lee JS. Impact of an intergenerational program to improve loneliness and social isolation in older adults initiated at the time of emergency department discharge: study protocol for a three-arm randomized clinical trial. Trials 2024; 25:425. [PMID: 38943176 PMCID: PMC11212444 DOI: 10.1186/s13063-024-08250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 06/18/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Social isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U? intervention using peer support from similar-aged volunteers and demonstrated reduced SIL among older adults discharged from the emergency department (ED). Generativity, defined as "the interest in establishing and guiding the next generation," can provide an alternative theoretical basis for reducing SIL via intergenerational programs between members of younger and older generations. The current protocol will examine the impact of younger intergenerational volunteers providing the HOW RU? INTERVENTION METHODS In this randomized clinical trial, we will compare the following three arms: (1) the standard same-generation peer support HOW R U? intervention, (2) HOW R U? intervention delivered by intergenerational volunteers, and (3) a common wait-list control group. Outcome assessors will be blinded to the intervention. Trained volunteers will deliver 12 weekly telephone support calls. We will recruit participants ≥ 70 years of age with baseline loneliness (six-item De Jong loneliness score of 2 or greater) from two EDs. Research staff will assess SIL, depression, quality of life, functional status, generativity, and perceived benefit at baseline, at 12 weeks, and 24 weeks post-intervention. DISCUSSION We hypothesize participants receiving the intergenerational intervention will show improved outcomes compared to the control group and peer support HOW R U? INTERVENTION We also hypothesize that participants with higher perceptions of generativity will have greater reductions in SIL than their lower generativity counterparts. Aging is experienced diversely, and social interventions combatting associated SIL should reflect that diversity. As part of a program of research following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, the findings of this RCT will be used to define which intervention characteristics are most effective in reducing SIL. TRIAL REGISTRATION ClinicalTrials.gov NCT05998343 Protocol ID:21-0074E. Registered on 24 July 2023.
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Affiliation(s)
- David Zheng
- Schulich School of Medicine and Dentistry, 1151 Richmond St, London, ON, N6A 5C1, Canada.
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Donald Melady
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Rohit Mohindra
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, North York General Hospital, Toronto, ON, Canada
| | - Samir Sinha
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Virginia Wesson
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Lesley Wiesenfeld
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Sabrina Kolker
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- Granovsky-Gluskin Family Medicine Centre, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Alex Kiss
- Department of Epidemiology and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacques S Lee
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Hooker SA, Crain AL, Muegge J, Rossom RC, Pronk NP, Pasumarthi DP, Kunisetty G, Masters KS. Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study. JMIR Form Res 2024; 8:e55722. [PMID: 38917457 PMCID: PMC11234062 DOI: 10.2196/55722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/12/2024] [Accepted: 05/04/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. OBJECTIVE This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. METHODS Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (-4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. RESULTS Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. CONCLUSIONS MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition.
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Affiliation(s)
- Stephanie A Hooker
- Division of Research and Evaluation, HealthPartners Institute, Minneapolis, MN, United States
| | - A Lauren Crain
- Division of Research and Evaluation, HealthPartners Institute, Minneapolis, MN, United States
| | - Jule Muegge
- Division of Research and Evaluation, HealthPartners Institute, Minneapolis, MN, United States
| | - Rebecca C Rossom
- Division of Research and Evaluation, HealthPartners Institute, Minneapolis, MN, United States
| | - Nicolaas P Pronk
- Division of Research and Evaluation, HealthPartners Institute, Minneapolis, MN, United States
| | | | - Gopikrishna Kunisetty
- Division of Research and Evaluation, HealthPartners Institute, Minneapolis, MN, United States
| | - Kevin S Masters
- Department of Psychology, University of Colorado Denver, Denver, CO, United States
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Cardinal É, Bilodeau K, Lebeau J, Aubin M, Guiné J, Dutey-Harispe O, Delage J, Caron-trahan R, Véronneau J, Landry M, Ogez D. Cultivating Comfort: Examining Participant Satisfaction with Hypnotic Communication Training in Pain Management. J Multidiscip Healthc 2024; 17:2973-2987. [PMID: 38948391 PMCID: PMC11213529 DOI: 10.2147/jmdh.s463738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Context One in four Canadians experiences chronic pain, yet insufficient services and restrictions surrounding prevailing treatments result in inadequate management and significant negative consequences for these individuals. Previous work indicates that hypnotic communication represents a promising complementary treatment; however, training protocols for healthcare professionals are underdeveloped and understudied. Aim To evaluate the level of satisfaction for a training program on hypnotic communication in pain management clinics. Design Qualitative study. Methods Six health professionals who first completed the hypnotic communication training participated in 30 minutes virtual semi-structured interviews. These testimonials allowed them to elaborate on their user experience and potential areas for improvement. Thematic analysis using qualitative data management software NVIVO was conducted on the interview data. Results Two themes emerged from the interviews. 1) Satisfaction: Participants expressed satisfaction on various structural aspects of the training, including the provided materials, atmosphere, training structure, presentation modalities, practical workshops, acquired knowledge, trainer quality, and training duration. 2) Areas for Improvement: Five main improvement suggestions were identified (providing more material; more practical workshops, more concrete and adapted; testimonials from former patients; follow-up training meeting; and continuing education). Implications for the Profession and/or Patient Care and Conclusion The results improved the training program to help minimized inherent biases related to this technique, cut associated costs, and identify reasons that would explain its underutilization among medical professionals in Quebec. Our work highlights that healthcare professionals in chronic pain management clinics (eg, respiratory therapists, nurses) can incorporate this simple hypnotic communication technique into their usual care and contribute to the well-being of patients. Impact This study aimed to address the lack of training protocols for healthcare professionals, that are underdeveloped and understudied. The main findings on participant' satisfaction and the areas of improvement for the training will help the refinement of the training to better suit healthcare professional's needs in hospitals and chronic pain facilities.
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Affiliation(s)
- Éloïse Cardinal
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Karine Bilodeau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Julie Lebeau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Maryse Aubin
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Joséphine Guiné
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Odile Dutey-Harispe
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Julie Delage
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Rémi Caron-trahan
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Jade Véronneau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Mathieu Landry
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - David Ogez
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Kirk H, Spencer-Smith M, Jobson L, Nicolaou E, Cornish K, Melzak E, Hrysanidis C, Moriarty C, Davey B, Whyman T, Bird L, Bellgrove MA. A digital intervention to support childhood cognition after the COVID-19 pandemic: a pilot trial. Sci Rep 2024; 14:14065. [PMID: 38890384 PMCID: PMC11189556 DOI: 10.1038/s41598-024-63473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Difficulties in executive functioning (EF) can result in impulsivity, forgetfulness, and inattention. Children living in remote/regional communities are particularly at risk of impairment in these cognitive skills due to reduced educational engagement and poorer access to interventions. This vulnerability has been exacerbated by the COVID-19 pandemic and strategies are needed to mitigate long-term negative impacts on EF. Here we propose a pilot trial investigating the benefits, feasibility, and acceptability of a school-based EF intervention for primary school students (6-8 years) living in regional, developmentally vulnerable, and socio-economically disadvantaged communities. Students were randomised to a digital intervention or teaching as usual, for 7 weeks. Children completed measures of EF and parents/educators completed ratings of everyday EF and social/emotional wellbeing at pre-intervention, post-intervention, and 3-month follow-up. Change in EFs (primary outcome), everyday EF, and social/emotional wellbeing (secondary outcomes) from pre- to post-intervention and pre-intervention to 3-month follow-up were examined. Feasibility and acceptability of the intervention was assessed through educator feedback and intervention adherence.Protocol Registration: The stage 1 protocol for this Registered Report was accepted in principle on 20 April 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/WT3S2 . The approved Stage 1 protocol is available here: https://osf.io/kzfwn .
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Affiliation(s)
- Hannah Kirk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.
| | - Megan Spencer-Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Laura Jobson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Nicolaou
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Kim Cornish
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Ebony Melzak
- Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Caitlin Hrysanidis
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Cassie Moriarty
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Belinda Davey
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Theoni Whyman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Laura Bird
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Mark A Bellgrove
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Nelson AK, Griest CJ, Munoz LM, Rumaldo N, Miller AC, Soplapuco GM, Lecca L, Shin SS, Acuña LR, Valdivia YV, Ramos AR, Ahumada DG, Ramos BRH, Mejia SA, Serrano EO, Castro WH, Oliva VE, Heyman AS, Hartwell LP, Blackwell RL, Diaz DF, Vibbert MM. Proof of concept of the Universal Baby video innovation for early child development in Lima, Peru. J Pediatr Psychol 2024:jsae035. [PMID: 38872286 DOI: 10.1093/jpepsy/jsae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE Community-based video interventions offer an effective and potentially scalable early interaction coaching tool for caregivers living in low resource settings. We tested the Universal Baby (UB) video innovation; an early interaction coaching tool using video sourced and produced locally with early child development (ECD) expert supervision. METHODS This proof-of-concept study enrolled 40 caregivers of children ages 10-18 months assigned to intervention and control groups by health establishments in Carabayllo, Lima, Peru. Mother/child dyads received 12 weekly group health education sessions with social support. Of those, 16 caregivers also received 6 UB videos featuring brain science education and local clips of responsive, reciprocal interaction, also known as "serve and return" interaction. Survey data assessed feasibility and acceptability of the intervention. We assessed improved quality of mother/child interaction using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO). RESULTS We found the program feasible. We successfully trained the local team to produce UB videos using locally-sourced footage and delivered the videos as part of a community-based intervention. We also found it to be acceptable in that participants enthusiastically received the UB videos, reporting they enjoyed being videotaped, and learned how to recognize and appropriately respond to their child's nuanced sounds and gestures. The median change in total PICCOLO scores favored the intervention group compared to the control group. CONCLUSIONS UB offers great potential as a sustainable, potentially scalable, and culturally appropriate tool to promote equity for child development among young children living in low resource homes globally.
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Affiliation(s)
- Adrianne K Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Blavatnik Institute, Harvard Medical School, Boston, MA, United States
| | | | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | - Sarah A Mejia
- Wheelock College of Education and Human Development, Boston University, Boston, MA, United States
| | | | | | | | - Annie S Heyman
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Lauren P Hartwell
- Boston University School of Public Health, Boston, MA, United States
| | - Ronnie L Blackwell
- Wheelock College of Education and Human Development, Boston University, Boston, MA, United States
| | | | - Martha M Vibbert
- Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Brown CEB, Richardson K, Halil-Pizzirani B, Hughes S, Atkins L, Pitt J, Yücel M, Segrave RA. PEAK Mood, Mind, and Marks: a pilot study of an intervention to support university students' mental and cognitive health through physical exercise. Front Psychiatry 2024; 15:1379396. [PMID: 38915845 PMCID: PMC11194434 DOI: 10.3389/fpsyt.2024.1379396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction Regular exercise has the potential to enhance university students' mental and cognitive health. The PEAK Mood, Mind and Marks program (i.e., PEAK) is a neuroscience-informed intervention developed using the Behaviour Change Wheel to support students to exercise three or more times per week to benefit their mental and cognitive health. This pilot study assessed the impact of PEAK on exercise, mental and cognitive health, and implementation outcomes. Methods PEAK was delivered to 115 undergraduate university students throughout a 12-week university semester. The primary outcome was weekly exercise frequency. Secondary outcomes were: time spent engaged in moderate-vigorous exercise, sedentary behaviour and perceived mental health and cognitive health. All were measured via online self-report questionnaires. Qualitative interviews with 15 students investigated influences on engagement, the acceptability and appropriateness of PEAK, and its mechanisms of behaviour change. Paired t-tests, Wilcoxon Signed-Rank tests and template analysis were used to analyse quantitative and qualitative data, respectively. Results On average, 48.4% of students engaged in the recommended frequency of three or more exercise sessions per week. This proportion decreased towards the end of PEAK. Sedentary behaviour significantly decreased from baseline to end-point, and moderate-vigorous exercise significantly increased among students' who were non-exercisers. Mental wellbeing, stress, loneliness, and sense of belonging to the university significantly improved. There were no significant changes in psychological distress. Concentration, memory, and productivity significantly improved. Sixty-eight percent of students remained engaged in one or more components of PEAK at end-point. Qualitative data indicated students found PEAK to be acceptable and appropriate, and that it improved aspects of their capability, opportunity, and motivation to exercise. Conclusions Students are receptive to an exercise-based program to support their mental and cognitive health. Students exercise frequency decreased; however, these figures are likely a conservative estimate of students exercise engagement. Students valued the neuroscience-informed approach to motivational and educational content and that the program's goals aligned with their academic goals. Students identified numerous areas PEAK's content and implementation can be optimised, including use of a single digital delivery platform, more opportunities to connect with peers and to expand the content's cultural inclusivity.
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Affiliation(s)
- Catherine E. B. Brown
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Karyn Richardson
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bengianni Halil-Pizzirani
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Sam Hughes
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Lou Atkins
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Joseph Pitt
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Murat Yücel
- Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rebecca A. Segrave
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Jimenez-Garcia JA, Gómez-Rodas A, DeMont R. Feasibility and Effects of a Neuromuscular Warm-Up Based on the Physical Literacy Model for 8-12-Year-Old-Children. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024:1-10. [PMID: 38842825 DOI: 10.1080/02701367.2024.2343361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/28/2024] [Indexed: 06/07/2024]
Abstract
Background: Physical literacy and injury prevention strategies use similar movement-related constructs and can be connected to develop comprehensive interventions. We aimed to test the feasibility and effects of a neuromuscular warm-up based on physical literacy and injury prevention strategies for 8-12-year-old children. Methods: We conducted a cluster non-randomized controlled trial. We defined a priori feasibility criteria and studied the effects of the intervention on physical literacy constructs, movement competence, and neuromuscular performance. We used generalized linear mixed models controlling for covariates and clustering with a significance level of 0.001. Results: We recruited 18 groups (n = 363) and randomly allocated nine to intervention (n = 179; female = 63.7%, age = 9.8 ± 1 years) and nine to control (n = 184, female = 53.3%, age = 9.9 ± 0.9 years). We met four of seven feasibility criteria (i.e. recruitment, adherence, enjoyment, perceived exertion). The three feasibility criteria that were not met (i.e. compliance, fidelity, follow-up) were slightly below the predefined threshold (90%). Model-adjusted mean differences for physical literacy constructs, movement competence, vertical jump height, horizontal jump distance, 20-m sprint time, and dynamic balance favored the intervention (p < .001). Conclusion: The feasibility evidence indicates that the intervention should be slightly modified before implementing it in a larger study. The observed mean differences are promising and can be used in planning future interventions.
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40
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Haley EN, Dolbier CL, Campbell LC, Carels RA, Braciszewski JM. Brief Self-Compassion Intervention for Women of Higher Weight and Internalized Weight Bias: A Randomized Pilot Study. Int J Behav Med 2024:10.1007/s12529-024-10297-z. [PMID: 38839712 DOI: 10.1007/s12529-024-10297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Internalized weight bias (IWB) negatively impacts mental and physical health, and disproportionately affects women of higher weight. Although self-compassion training may be advantageous for reducing IWB and associated sequalae, further examination of its clinical significance and cultural acceptability is warranted. METHOD A randomized pilot study was conducted to evaluate the feasibility, including cultural acceptability, and clinical significance of a 3-session self-compassion intervention (SCI) for women with IWB. Women with BMIs of > 25 and IWB (N = 34) were randomly assigned to the SCI or a waitlist control group. Participants completed pre, post, and 1-month follow-up surveys on IWB, self-compassion, body image, eating behaviors, physical activity, and affect. Analyses of covariance were employed and percentages of change were calculated to examine post-intervention between-group differences in outcomes. Cultural acceptability was evaluated through participants' ratings of the perceived inclusivity and relevancy of the SCI. RESULTS There were 59% (n = 10) and 47% (n = 8) completion rates in the SCI and waitlist control groups, respectively. Compared to the waitlist control group, SCI participants reported greater pre-post improvements in self-compassion, IWB, body shame and surveillance, uncontrolled eating, and physical activity with medium to large effect sizes, and emotional eating with small effects. The SCI was perceived to be beneficial overall, and cultural acceptability ratings were mostly favorable despite individual differences. CONCLUSION This brief SCI may be beneficial for women impacted by weight stigma and IWB. Attention to increased diversity and cultural acceptability is warranted in future trials.
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Affiliation(s)
- Erin N Haley
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA.
| | | | - Lisa C Campbell
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Robert A Carels
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
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Strohacker K, Sudeck G, Keegan R, Ibrahim AH, Beaumont CT. Contextualising flexible nonlinear periodization as a person-adaptive behavioral model for exercise maintenance. Health Psychol Rev 2024; 18:285-298. [PMID: 37401403 DOI: 10.1080/17437199.2023.2233592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
There is a growing focus on developing person-adaptive strategies to support sustained exercise behaviour, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodisation (FNLP) - a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning - that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behaviour evidence and theory to propose a modified FNLP model and to show hypothesised pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation.
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Affiliation(s)
- Kelley Strohacker
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Gorden Sudeck
- Institute of Sport Science, Eberhard Karls University of Tübingen, Tübingen, Germany
- Interfacultary Research Institute for Sports and Physical Activity, University of Tübingen, Tübingen, Germany
| | - Richard Keegan
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, Australia
| | - Adam H Ibrahim
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Cory T Beaumont
- Department of Allied Health, Sport, and Wellness, Baldwin Wallace University, Berea, OH, USA
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42
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McGoron L, Towner EK, Martel MM, Trentacosta CJ, Purkayestha S, Friedrich FS, Traylor P, Ondersma SJ. Developing the Technology-based Parenting Young Children Check-Up Intervention for Disruptive Behavior Problems Identified in Pediatric Primary Care. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2024; 12:128-142. [PMID: 39021503 PMCID: PMC11251713 DOI: 10.1037/cpp0000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Objective Behavioral parent training programs show clear efficacy and effectiveness in response to young children's disruptive behavior problems, but limitations in engagement and accessibility prevent many families from benefiting from these programs. The Parenting Young Children Check-up (PYCC) is a technology-based program designed to overcome these barriers and increase the reach of behavioral parent training. Developed for use in pediatric health care, the PYCC includes three components: 1) an initial check-up designed to motivate program involvement; 2) text messages to connect parents with program content and reinforce content; and 3) a parent training website involving video-based content to teach parenting skills. This report details initial steps to refine PYCC intervention components. Methods Seventeen mothers and 17 primary care physicians participated in this mixed methods data collection across three iterations by providing feedback on early drafts of the three components of the PYCC and completing a feedback questionnaire. Results Feedback from one iteration informed modifications that were then evaluated in subsequent iterations. Saturation of qualitative input, positive qualitative feedback, and positive quantitative ratings on the feedback questionnaire was achieved in iteration three. Conclusions Outcomes of this investigation informed the full version of the PYCC that will subsequently be tested in a proof-of-concept trial. Implications for Impact Statement Several barriers limit the reach of parenting skills programs that reduce child problem behavior. We gathered feedback from parents and physicians to refine a parenting program that uses technology and delivery in pediatrics to overcome barriers. Future testing of the program will further inform implementation in pediatric settings.
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Affiliation(s)
- Lucy McGoron
- Merrill Palmer Skillman Institute for Child & Family
Development, Wayne State University
| | - Elizabeth K. Towner
- Merrill Palmer Skillman Institute for Child & Family
Development, Wayne State University
- Department of Family Medicine and Public Health Sciences,
Wayne State University
| | | | - Christopher J. Trentacosta
- Merrill Palmer Skillman Institute for Child & Family
Development, Wayne State University
- Department of Psychology, Wayne State University
| | - Sharmi Purkayestha
- Merrill Palmer Skillman Institute for Child & Family
Development, Wayne State University
| | | | - Parris Traylor
- Merrill Palmer Skillman Institute for Child & Family
Development, Wayne State University
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43
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Jandasek BN, Kopel SJ, Esteban CA, Rudders SA, Spitalnick JS, Larsen MA, Cushman GK, McQuaid EL. Friends, Family, and Food: Development of a Food Allergy Intervention, F3-App, for Children. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2024; 12:143-156. [PMID: 39045229 PMCID: PMC11262568 DOI: 10.1037/cpp0000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Objective Despite a marked increase in the prevalence of pediatric IgE-mediated food allergy (FA) in recent decades, there is a dearth of age-appropriate management education and support tools for youth with FA. The purpose of this report is to detail our methods for intervention design and refinement of an interactive educational software program for school-aged children with FA. Methods Development of the "Friends, Family and Food Application (F3-App)" employed an iterative, user-centered design approach with input from children with FA, their caregivers, and other key experts. Phase 1 (Prototype Development/Pilot Evaluation) involved family input on key themes and educational messages, development of a prototype, and pilot testing. Phase 2 (Full F3-App Development/Open Trial) included refinement and expansion of the prototype per advisory panel and end-user recommendations, followed by an open trial with additional iterative refinement. Results Acceptability and credibility of the F3-App were rated highly by most participants. Relatively few technical challenges arose with F3-App installation or use. Follow up interviews with children and caregivers suggested that the F3-App was generally well-received, families found the content useful, and that it prompted family discussion about the child's FA management. Conclusions User input is critical to developing family-friendly software to support management of pediatric chronic conditions. Interactive educational software can be a useful channel for children to practice skills and build confidence in disease self-management and to facilitate family communication regarding the stresses of FA management. Trial registration ClinicalTrials.gov identifier: NCT05111938.
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Affiliation(s)
- Barbara N Jandasek
- Bradley Hasbro Children's Research Center, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
- Department of Pediatrics, Alpert Medical School of Brown University
| | - Sheryl J Kopel
- Bradley Hasbro Children's Research Center, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
- Department of Pediatrics, Alpert Medical School of Brown University
| | - Cynthia A Esteban
- Bradley Hasbro Children's Research Center, Rhode Island Hospital
- Department of Pediatrics, Alpert Medical School of Brown University
| | - Susan A Rudders
- Department of Pediatrics, Alpert Medical School of Brown University
| | | | | | - Grace K Cushman
- Bradley Hasbro Children's Research Center, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Elizabeth L McQuaid
- Bradley Hasbro Children's Research Center, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
- Department of Pediatrics, Alpert Medical School of Brown University
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Levesque A, Ogez D, Gravel V, Marcil V, Curnier D, Rondeau É, Sinnett D, Péloquin K, Sultan S. Feasibility Study of Taking Back Control Together, an Intervention to Support Parents of Children with Cancer. J Clin Psychol Med Settings 2024; 31:444-454. [PMID: 38127090 DOI: 10.1007/s10880-023-09998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Parents of children with cancer can experience increased emotional distress. This study aimed to assess the feasibility (i.e., reach, treatment fidelity, and social validity) of Taking Back Control Together (TBCT). METHODS We assessed reach with the enrollment and dropout ratios. We assessed treatment fidelity using items from existing programs, controlling for the reliability of the items. For social validity, we used an adapted version of the Treatment Evaluation Inventory and compared means with theoretical cut-points. RESULTS 42 participants enrolled in the intervention. The enrollment and dropout ratios were 39% and 38%, respectively. Treatment fidelity was 77.3-84.3% (95%CI 75.3-86%). Acceptability (M = 90%), satisfaction (M = 87%), and relevance (M = 82%) were significantly positive. CONCLUSION This study suggests that certain elements of TBCT need to be reassessed before the intervention is pilot tested. Although reach was likely impacted by the COVID-19 pandemic, it could be improved with some modifications to the intervention.
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Affiliation(s)
- Ariane Levesque
- Department of Psychology, Université de Montreal, Montreal, Canada
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
| | - David Ogez
- Department of Psychology, Université de Montreal, Montreal, Canada
- Department of Anesthesiology, Université de Montreal, Montreal, Canada
| | - Vivianne Gravel
- Department of Psychology, Université de Montreal, Montreal, Canada
| | - Valérie Marcil
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Nutrition, Université de Montreal, Montreal, Canada
| | - Daniel Curnier
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montreal, Montreal, Canada
| | - Émélie Rondeau
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
| | - Daniel Sinnett
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, Université de Montreal, Montreal, Canada
| | | | - Serge Sultan
- Department of Psychology, Université de Montreal, Montreal, Canada.
- Research Center, Sainte-Justine University Health Center, Montreal, Canada.
- Department of Pediatrics, Université de Montreal, Montreal, Canada.
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Klejc K, Cruz-Almeida Y, Sheffler JL. Addressing Pain Using a Mediterranean Ketogenic Nutrition Program in Older Adults with Mild Cognitive Impairment. J Pain Res 2024; 17:1867-1880. [PMID: 38803693 PMCID: PMC11129704 DOI: 10.2147/jpr.s451236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Chronic pain has negative physical and cognitive consequences in older adults and may lead to a poorer quality of life. Mediterranean ketogenic nutrition (MKN) is a promising nonpharmacological intervention for pain management, but long-term adherence is challenging due to the carbohydrate restrictive diet regimen. The main objective of this study was to evaluate the effects of the pilot MKN Adherence (MKNA) Program on pain in older adults with mild cognitive impairment and to assess whether improvements in self-reported pain were associated with adherence to MKN. Older adults (N = 58) aged 60-85 with possible mild cognitive impairment were randomized to a 6-week MKNA arm or an MKN Education (MKNE) program arm. Both arms received the same nutrition education and group format; however, the MKNA arm received additional motivational interviewing and cognitive behavioral skills to enhance adherence. Changes in self-reported pain (Brief Pain Inventory, Roland Morris, Patient's Global Impression of Change) and adherence to MKN (ketone levels, self-reported adherence) were assessed at baseline, 6-weeks, and 3-months post intervention. Both arms showed clinically significant reductions in pain. Greater adherence to MKN across the 6-week intervention was associated with higher ratings of pain-related changes on the Patient's Global Impression of Change scale. Based on these findings, adherence to MKN may promote improvements in self-reported pain in older adults with mild cognitive impairment and findings support the need for future full-scale randomized clinical trials evaluating MKN programs on pain. Trial Registration: Clinicaltrials.gov ID: NCT04817176.
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Affiliation(s)
- Kamelia Klejc
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Yenisel Cruz-Almeida
- Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL, USA
| | - Julia L Sheffler
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
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Rouleau CR, Chirico D, Wilton SB, MacDonald MK, Tao T, Arena R, Campbell T, Aggarwal S. Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e033568. [PMID: 38761079 PMCID: PMC11179828 DOI: 10.1161/jaha.123.033568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/04/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. METHODS AND RESULTS A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). CONCLUSIONS Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.
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Affiliation(s)
- Codie R Rouleau
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Psychology University of Calgary Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | | | - Stephen B Wilton
- TotalCardiology Research Network Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | | | - Tianqi Tao
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | - Ross Arena
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago IL
| | - Tavis Campbell
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Psychology University of Calgary Calgary Alberta Canada
| | - Sandeep Aggarwal
- TotalCardiology Research Network Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
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Maas E. Treatment for Childhood Apraxia of Speech: Past, Present, and Future. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-26. [PMID: 38768073 DOI: 10.1044/2024_jslhr-23-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS. METHOD Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?" RESULTS A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied. CONCLUSIONS A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.
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Affiliation(s)
- Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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Menezes M, Burroughs C, Pappagianopoulos J, Sadikova E, Fuhrmann E, Bohac G, Cross R, Witte L, Brinkmann G, Lemley R, Sukhodolsky DG, Mazurek MO. Feasibility and preliminary efficacy of behavioral activation for treatment of depression in autistic adolescents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241252470. [PMID: 38764234 DOI: 10.1177/13623613241252470] [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: 05/21/2024]
Abstract
LAY ABSTRACT Depression is common among autistic youth and has a significant negative impact on quality of life and day-to-day functioning. Despite great need for efficacious treatments, there are currently limited research-supported interventions for depression symptoms in autistic young people. This study tested a novel, behavior-based approach or psychotherapy for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A) with 15 youth (11-16 years old). BA-A is an individually delivered 12-session therapy that was developed for and to meet the needs of autistic youth with depression. Results found that autistic youth and their caregivers were able to participate in BA-A therapy sessions, and clinicians were able to deliver BA-A in accordance with the treatment manual. Notably, results demonstrated that autistic youth depression symptoms significantly improved after participating in BA-A. Furthermore, anxiety symptoms and social skills significantly improved following BA-A.
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Affiliation(s)
| | | | | | - Eleonora Sadikova
- Vanderbilt University Medical Center, USA
- University of Virginia, USA
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Kepper M, Walsh-Bailey C, Miller ZM, Zhao M, Zucker K, Gacad A, Herrick C, White NH, Brownson RC, Foraker RE. The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study. JMIR Form Res 2024; 8:e55731. [PMID: 38758581 PMCID: PMC11143394 DOI: 10.2196/55731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. OBJECTIVE The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. METHODS A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. RESULTS PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). CONCLUSIONS Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193.
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Affiliation(s)
- Maura Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Zoe M Miller
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Min Zhao
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States
| | - Kianna Zucker
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Angeline Gacad
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cynthia Herrick
- Division of Endocrinology, Washington University School of Medicine, St. Louis, MO, United States
| | - Neil H White
- Division of Pediatric Endocrinology & Diabetes, Washington University School of Medicine, St. Louis, MO, United States
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States
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Mancinelli E, Gabrielli S, Salcuni S. A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study. JMIR Hum Factors 2024; 11:e50098. [PMID: 38753421 PMCID: PMC11140274 DOI: 10.2196/50098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/05/2023] [Accepted: 03/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. OBJECTIVE This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women's needs. Usability and user engagement were evaluated. METHODS A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. RESULTS Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention's goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. CONCLUSIONS Overall, the findings have emphasized both the intervention's merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention's content to pregnant women's needs.
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Affiliation(s)
- Elisa Mancinelli
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
- Fondazione Bruno Kessler, Trento, Italy
| | | | - Silvia Salcuni
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
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