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Sweeney AM, Wilson DK, Van Horn ML, Zarrett N, Resnicow K, Brown A, Quattlebaum M, Gadson B. Results from "Developing Real Incentives and Volition for Exercise" (DRIVE): A pilot randomized controlled trial for promoting physical activity in African American women. J Consult Clin Psychol 2022; 90:747-759. [PMID: 35834196 PMCID: PMC9669192 DOI: 10.1037/ccp0000740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Motivation is a barrier to physical activity (PA) among African American (AA) women, but past studies have implemented a "one-size-fits-all" approach and have not addressed differences in autonomous motivation. This pilot randomized controlled trial assessed the preliminary efficacy of "Developing Real Incentives and Volition for Exercise," a community- and theory-based intervention, which evaluated whether a motivationally matched (vs. a nonmatched) intervention increases daily total PA. METHOD In total, 68 AA women (50.72 ± 13.66 years; 86.8% with obesity) were randomized to an 8-week challenge-focused program (targeted toward high autonomous motivation) or rewards-focused program (targeted toward low autonomous motivation). Randomization was stratified by baseline autonomous motivation. FitBits were used during the intervention to promote self-monitoring (both programs) and social connectedness (challenge program only). RESULTS Both programs retained ≥ 80% of participants. Process evaluation revealed high attendance, dose, and fidelity (both programs). However, contrary to expectations, across all motivational levels (low and high autonomous), the challenge-focused intervention resulted in a greater increase in total daily PA (primary outcome), with an average increase of 17.9 min in the challenge-focused intervention versus an average decrease of 8.55 min in the rewards-focused intervention. An exploratory follow-up analysis revealed that engagement with the FitBit mobile app predicted greater PA at postintervention in the challenge-focused program. CONCLUSIONS A team-based approach targeting social connectedness, enjoyment of PA, and positive intragroup competition is a promising approach for promoting PA among AA women. These findings are used to guide a discussion on best practices for engaging AA women in future behavioral interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina
| | - M Lee Van Horn
- Department of Education Psychology, University of New Mexico
| | | | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Asia Brown
- Department of Psychology, University of South Carolina
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Hodson N, Majid M, Vlaev I, Singh SP. Can incentives improve antipsychotic adherence in major mental illness? A mixed-methods systematic review. BMJ Open 2022; 12:e059526. [PMID: 35705342 PMCID: PMC9204416 DOI: 10.1136/bmjopen-2021-059526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Incentives have been effectively used in several healthcare contexts. This systematic review aimed to ascertain whether incentives can improve antipsychotic adherence, what ethical and practical issues arise and whether existing evidence resolves these issues. DESIGN Systematic review of MEDLINE, EMBASE and PsycINFO. Searches on 13 January 2021 (no start date) found papers on incentives for antipsychotics. Randomised controlled trials (RCTs), cohort studies, qualitative research and ethical analyses were included. Papers measuring impact on adherence were synthesised, then a typology of ethical and policy issues was compiled, finally the empirical literature was compared with this typology to describe current evidence and identify remaining research questions. RESULTS 26 papers were included. 2 RCTs used contingent financial incentives for long-acting injectable antipsychotic preparations. Over 12 months, there were significantly larger increases in adherence among the intervention groups versus control groups in both RCTs. There were no consistently positive secondary outcomes. 39 ethical and practical issues were identified. 12 of these are amenable to empirical study but have not been researched and for 7 the current evidence is mixed. CONCLUSIONS In keeping with other areas of healthcare, antipsychotic adherence can be increased with financial incentives. Payments of 2.5 times minimum wage changed behaviour. The typology of issues reported in this systematic review provides a template for future policy and ethical analysis. The persistence of the effect and the impact of incentives on intrinsic motivation require further research. PROSPERO REGISTRATION NUMBER CRD42020222702.
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Affiliation(s)
- Nathan Hodson
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Madiha Majid
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Ivo Vlaev
- Warwick Business School, Coventry, UK
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Issues surrounding incentives and penalties for COVID-19 vaccination: The Israeli experience. Prev Med 2021; 153:106763. [PMID: 34352308 PMCID: PMC8327565 DOI: 10.1016/j.ypmed.2021.106763] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022]
Abstract
The purpose of this study was to examine patterns of COVID-19 vaccination in Israel and how these relate to different proposals made about benefits for those vaccinated, and to present the legal and ethical dilemmas surrounding these issues. A retrospective study of COVID-19 vaccination rates in Israel was conducted, with data obtained from the Ministry of Health (MOH). Information on benefits proposed or offered for vaccination and restrictions for non-vaccination were obtained from the MOH and presented in a timeline. By March 1st, 51% of the total population, and 91% of those aged 60 and over, had received their first COVID-19 vaccine. Exemption from quarantine was granted to vaccinated or recovered people from 17th January 2021. The 'green pass' incentive scheme, granting access to social, cultural and sporting events for those fully vaccinated or immune, was proposed in December 2020, and came into effect on February 21st 2021. Incentive schemes which impose limitations on those who choose not to vaccinate may motivate some people to take action. Policymakers should use a measured approach to protect public health, with minimum infringement on citizens' rights. Providing transparent and culturally appropriate information on immunization and ensuring maximal and equitable access to COVID-19 vaccines may help build trust.
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Behavioral weight loss in emerging adults: Design and rationale for the Richmond Emerging Adults Choosing Health (REACH) randomized clinical trial. Contemp Clin Trials 2021; 107:106426. [PMID: 34044124 DOI: 10.1016/j.cct.2021.106426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/15/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the U.S., over 40% of 18-25 year olds meet criteria for overweight or obesity. Yet, no large-scale trials have targeted this age group for behavioral weight loss (BWL). Formative data revealed that existing BWL programs do not meet their unique needs and identified motivation as a fundamental barrier for weight management. The goal of the Richmond Emerging Adults Choosing Health (REACH) trial was to test the efficacy of two mHealth lifestyle interventions specifically focused on enhancing motivation, relative to adapted standard. METHODS Participants (N = 381, 18-25 years, body mass index 25-45 kg/m2) will be randomized to 1) adapted BWL (aBWL), 2) aBWL + self-determination theory (aBWL+SDT), or 3) aBWL + behavioral economics (aBWL+BE). All arms will receive a 6-month intervention, delivered via one group session and one individual session, followed by an mHealth platform. Assessments will occur at baseline, 3-months, 6-months (post-treatment) and 12-months (following a no-contact period). The primary aim is to compare weight loss outcomes at 6 months. Secondary aims include changes at 6-months in physical and behavioral cardiometabolic risk factors, as well as psychosocial measures. We will also explore weight loss maintenance, change in hypothesized mediators, and moderators of treatment response. DISCUSSION REACH is the first large-scale BWL trial designed specifically for emerging adults. Further, it will be the first trial to compare a lifestyle intervention grounded in self-determination theory to one rooted in behavioral economics. If clinically significant reductions in adiposity are achieved, findings could inform a scalable treatment model to meet the needs of this vulnerable population. TRIAL REGISTRATION NCT02736981.
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Wittleder S, Smith S, Wang B, Beasley JM, Orstad SL, Sweat V, Squires A, Wong L, Fang Y, Doebrich P, Gutnick D, Tenner C, Sherman SE, Jay M. Peer-Assisted Lifestyle (PAL) intervention: a protocol of a cluster-randomised controlled trial of a health-coaching intervention delivered by veteran peers to improve obesity treatment in primary care. BMJ Open 2021; 11:e043013. [PMID: 33637544 PMCID: PMC7919589 DOI: 10.1136/bmjopen-2020-043013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Among US veterans, more than 78% have a body mass index (BMI) in the overweight (≥25 kg/m2) or obese range (≥30 kg/m2). Clinical guidelines recommend multicomponent lifestyle programmes to promote modest, clinically significant body mass (BM) loss. Primary care providers (PCPs) often lack time to counsel and refer patients to intensive programmes (≥6 sessions over 3 months). Using peer coaches to deliver obesity counselling in primary care may increase patient motivation, promote behavioural change and address the specific needs of veterans. We describe the rationale and design of a cluster-randomised controlled trial to test the efficacy of the Peer-Assisted Lifestyle (PAL) intervention compared with enhanced usual care (EUC) to improve BM loss, clinical and behavioural outcomes (aim 1); identify BM-loss predictors (aim 2); and increase PCP counselling (aim 3). METHODS AND ANALYSIS We are recruiting 461 veterans aged 18-69 years with obesity or overweight with an obesity-associated condition under the care of a PCP at the Brooklyn campus of the Veterans Affairs NY Harbor Healthcare System. To deliver counselling, PAL uses in-person and telephone-based peer support, a tablet-delivered goal-setting tool and PCP training. Patients in the EUC arm receive non-tailored healthy living handouts. In-person data collection occurs at baseline, month 6 and month 12 for patients in both arms. Repeated measures modelling based on mixed models will compare mean BM loss (primary outcome) between study arms. ETHICS AND DISSEMINATION The protocol has been approved by the Institutional Review Board and the Research and Development Committee at the VA NY Harbor Health Systems (#01607). We will disseminate the results via peer-reviewed publications, conference presentations and meetings with stakeholders. TRIAL REGISTRATION NUMBER NCT03163264; Pre-results.
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Affiliation(s)
- Sandra Wittleder
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Shea Smith
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Binhuan Wang
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Jeannette M Beasley
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Stephanie L Orstad
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Victoria Sweat
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Laura Wong
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Yixin Fang
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Paula Doebrich
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Damara Gutnick
- Department of Epidemiology & Population Health, Department of Family & Social Medicine, Department of Psychiatry & Behavioral Sciences, The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Craig Tenner
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
- Veterans Affairs New York Harbor Healthcare System, Veterans Health Administration, New York City, New York, USA
| | - Scott E Sherman
- Veterans Affairs New York Harbor Healthcare System, Veterans Health Administration, New York City, New York, USA
- Department of Population Health, Department of Medicine, Department of Psychiatry, New York University School of Medicine, New York City, New York, USA
| | - Melanie Jay
- Veterans Affairs New York Harbor Healthcare System, Veterans Health Administration, New York City, New York, USA
- Department of Medicine, Department of Population Health, New York University School of Medicine, New York City, New York, USA
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Wittleder S, Ajenikoko A, Bouwman D, Fang Y, McKee MD, Meissner P, Orstad SL, Rehm CD, Sherman SE, Smith S, Sweat V, Velastegui L, Wylie-Rosett J, Jay M. Protocol for a cluster-randomized controlled trial of a technology-assisted health coaching intervention for weight management in primary care: The GEM (goals for eating and moving) study. Contemp Clin Trials 2019; 83:37-45. [PMID: 31229622 DOI: 10.1016/j.cct.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/30/2019] [Accepted: 06/19/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Over one-third of American adults have obesity with increased risk of chronic disease. Primary care providers often do not counsel patients about weight management due to barriers such as lack of time and training. To address this problem, we developed a technology-assisted health coaching intervention called Goals for Eating and Moving (GEM) to facilitate obesity counseling within the patient-centered medical home (PCMH) model of primary care. The objective of this paper is to describe the rationale and design of a cluster-randomized controlled trial to test the GEM intervention when compared to Enhanced Usual Care (EUC). METHOD We have randomized 19 PCMH teams from two NYC healthcare systems (VA New York Harbor Healthcare System and Montefiore Medical Group practices) to either the GEM intervention or EUC. Eligible participants are English and Spanish-speaking primary care patients (ages 18-69 years) with obesity or who are overweight with comorbidity (e.g., arthritis, sleep apnea, hypertension). The GEM intervention consists of a tablet-delivered goal setting tool, a health coaching visit and twelve telephone calls for patients, and provider counseling training. Patients in the EUC arm receive health education materials. The primary outcome is mean weight loss at 1 year. Secondary outcomes include changes in waist circumference, diet, and physical activity. We will also examine the impact of GEM on obesity-related provider counseling competency and attitudes. CONCLUSION If GEM is found to be efficacious, it could provide a structured approach for improving weight management for diverse primary care patient populations with elevated cardiovascular disease risk.
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Affiliation(s)
- Sandra Wittleder
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - Adefunke Ajenikoko
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - Dylaney Bouwman
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - Yixin Fang
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Stephanie L Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - Colin D Rehm
- Office of Community & Population Health, Montefiore Medical Center, 3514 Dekalb Ave, Bronx, NY 10467, USA.
| | - Scott E Sherman
- Department of Population Health, New York University School of Medicine, 550 1(st) Avenue, New York, NY 10016, USA; Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA.
| | - Shea Smith
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - Victoria Sweat
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - Lorena Velastegui
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Melanie Jay
- Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA; Department of Medicine and Population Health, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
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Abstract
PURPOSE OF REVIEW Emerging adulthood (age 18-25) represents a critical period for weight control: rate of weight gain is greatest during these years and the prevalence of overweight and obesity is estimated to be at least 40% among emerging adults. Unique behavioral, psychosocial, and cognitive risk factors among this population must be specifically addressed within weight management programs. We review extant treatment approaches, including lessons learned from the nascent literature specifically targeting this population. Lastly, we provide suggestions to inform future work in this area. RECENT FINDINGS The EARLY consortium comprises seven clinical trials targeting weight control in young adults age 18-35. Though these studies encompass a broader age range, two of the trials enrolled large numbers of 18-25-year-olds. Results from these trials and other recent pilot trials provide a foundation for next steps with respect to developing weight management interventions for emerging adults. The design of targeted weight control approaches for emerging and young adults has contributed to improved outcomes for this high-risk population. However, suboptimal engagement and variability in response pose challenges. Identifying and intervening on individual-level behavioral and psychological variables may enhance the effects of these adapted treatments.
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Affiliation(s)
- Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street Box 842018, Richmond, VA, 23284, USA
| | - Kristal L Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA
| | - Jessica G LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA.
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