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Krukowski RA, Ross KM, Western MJ, Cooper R, Busse H, Forbes C, Kuntsche E, Allmeta A, Silva AM, John-Akinola YO, König LM. Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process. Trials 2024; 25:98. [PMID: 38291539 PMCID: PMC10826214 DOI: 10.1186/s13063-024-07937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Digital interventions offer many possibilities for improving health, as remote interventions can enhance reach and access to underserved groups of society. However, research evaluating digital health interventions demonstrates that such technologies do not equally benefit all and that some in fact seem to reinforce a "digital health divide." By better understanding these potential pitfalls, we may contribute to narrowing the digital divide in health promotion. The aim of this article is to highlight and reflect upon study design decisions that might unintentionally enhance inequities across key research stages-recruitment, enrollment, engagement, efficacy/effectiveness, and retention. To address the concerns highlighted, we propose strategies including (1) the standard definition of "effectiveness" should be revised to include a measure of inclusivity; (2) studies should report a broad range of potential inequity indicators of participants recruited, randomized, and retained and should conduct sensitivity analyses examining potential sociodemographic differences for both the effect and engagement of the digital interventions; (3) participants from historically marginalized groups should be involved in the design of study procedures, including those related to recruitment, consent, intervention implementation and engagement, assessment, and retention; (4) eligibility criteria should be minimized and carefully selected and the screening process should be streamlined; (5) preregistration of trials should include recruitment benchmarks for sample diversity and comprehensive lists of sociodemographic characteristics assessed; and (6) studies within trials should be embedded to systematically test recruitment and retention strategies to improve inclusivity. The implementation of these strategies would enhance the ability of digital health trials to recruit, randomize, engage, and retain a broader and more representative population in trials, ultimately minimizing the digital divide and broadly improving population health.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
| | - Kathryn M Ross
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Max J Western
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Cynthia Forbes
- Hull York Medical School, University of Hull, Allam Medical Building, Cottingham Road, Hull, UK
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, 3086 VIC, Australia
| | - Anila Allmeta
- University of Bayreuth, Fritz-Hornschuch-Straße 13, 95326, Kulmbach, Germany
| | - Anabelle Macedo Silva
- Instituto de Estudos Em Saúde Coletiva IESC/ Universidade Federal Do Rio de Janeiro /Leibiniz Science Campus Digital Public Health/Ministério Público Do Estado Do Rio de Janeiro, Rua das Bauhineas 200, Bl B 1602, Península, Barra da Tijuca, Rio de Janeiro, 22776-090, Brazil
| | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, College of Medicine, Queen Elizabeth Road, UCH Campus, Ibadan, Nigeria
| | - Laura M König
- University of Bayreuth, Faculty of Life Sciences: Food, Nutrition and Health University of Vienna, Faculty of Psychology, Wächtergasse 1, 1010, Vienna, Austria
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Aldridge G, Tomaselli A, Nowell C, Reupert A, Jorm A, Yap MBH. Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review. J Med Internet Res 2024; 26:e43994. [PMID: 38241066 PMCID: PMC10837762 DOI: 10.2196/43994] [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: 11/01/2022] [Revised: 04/28/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal. OBJECTIVE This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. METHODS Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. RESULTS We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. CONCLUSIONS This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. TRIAL REGISTRATION PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.
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Affiliation(s)
- Grace Aldridge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alessandra Tomaselli
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Clare Nowell
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Monash University, Clayton, Australia
| | - Anthony Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marie Bee Hui Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Kushniruk A, Middelweerd A, van Empelen P, Preuhs K, Konijnendijk AAJ, Oude Nijeweme-d'Hollosy W, Schrijver LK, Laverman GD, Vollenbroek-Hutten MMR. A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study. JMIR Hum Factors 2023; 10:e40017. [PMID: 36633898 PMCID: PMC9947918 DOI: 10.2196/40017] [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: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). OBJECTIVE This paper aimed to describe the systematic development of E-Supporter 1.0. METHODS Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. RESULTS The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. CONCLUSIONS The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.
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Affiliation(s)
| | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | | | | | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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Fitzgeraldson E, Triandafilidis Z, Franklin Y, Palazzi K, Kay-Lambkin F, Fitzpatrick S. Feasibility and Acceptability of a Novel Online Program for Mental Health Carers. Int J Psychol Res (Medellin) 2023; 16:41-55. [PMID: 37547866 PMCID: PMC10402641 DOI: 10.21500/20112084.5733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 08/08/2023] Open
Abstract
Objective To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms. Methods Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups. Results Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control. Conclusions The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.
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Affiliation(s)
- E Fitzgeraldson
- Everymind, Newcastle, Australia. University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Z Triandafilidis
- School of Medicine and Public, University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Y Franklin
- Everymind, Newcastle, Australia. Australia
| | - K Palazzi
- Everymind, Newcastle, Australia. Australia
| | - F Kay-Lambkin
- Hunter Medical Research Institute, New Lambton Heights, Australia. Hunter Medical Research InstituteAustralia
| | - S Fitzpatrick
- University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
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Hoffmann C, Schaller A. Evaluation of the communication strategy for promoting physical activity in a cross-company network in Germany: A mixed-methods analysis. Front Public Health 2022; 10:905451. [PMID: 36589998 PMCID: PMC9799332 DOI: 10.3389/fpubh.2022.905451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The workplace is considered a promising setting for reaching physically inactive adults, but participation quotes in workplace health promotion (WHP) remain low. Regarding the low participation in WHP, the question emerges concerning the importance of health communication strategies. This paper presents the results from the evaluation of the communication strategy of a cross-company network for promoting physical activity and derives findings for the successful communication of measures. Materials and methods Quantitative and qualitative data sources were used to evaluate the communication strategy. The methods applied included individual semi-structured interviews (n = 14) and the monitoring of the usage of digital communication channels. Results The analysis revealed that the usage of the digital communication channels within this study was subjected to major fluctuations and a variety of factors must be considered when communicating physical activity measures in a cross-company network. It is important to engage in appropriate communication management that explicitly takes the interpersonal communication and the organizational circumstances into account. Conclusion This study revealed which factors may have an influence on the successful communication of physical activity measures in the context of WHP in cross-company networks. Thus, it makes an important contribution to the transfer of science and practice as it captured relevant questions from the field of WHP. Trial registration German Clinical Trials Register (DRKS)-ID: DRKS00020956; Date of registration: 18 June 2020, https://drks.de/search/de/trial/DRKS00020956.
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Affiliation(s)
- Carina Hoffmann
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
- Department Research and Development, Institute for Occupational Health Promotion, Cologne, Germany
| | - Andrea Schaller
- Working Group Physical Activity-Related Prevention Research, Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
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Kaseva K, Tervaniemi M, Heikura E, Kostilainen K, Pöyhönen-Alho M, Shoemaker JK, Petrella RJ, Peltonen JE. Identifying Personality Characteristics and Indicators of Psychological Well-Being Associated With Attrition in the Motivation Makes the Move! Physical Activity Intervention: Randomized Technology-Supported Trial. JMIR Form Res 2022; 6:e30285. [PMID: 36427239 PMCID: PMC9736762 DOI: 10.2196/30285] [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: 05/16/2021] [Revised: 03/01/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Data attrition has been a common problem in longitudinal lifestyle interventions. The contributors to attrition in technology-supported physical activity interventions have not been thoroughly studied. OBJECTIVE The present study examined the roles of personality characteristics and indicators of psychological well-being in data attrition within a technology-supported, longitudinal intervention study with overweight adults. METHODS Participants (N=89) were adults from the Motivation Makes the Move! intervention study. Data attrition was studied after a 3-month follow-up. Participants' personality characteristics were studied using the Short Five self-report questionnaire. Psychological well-being indicators were assessed with the RAND 36-item health survey, Positive and Negative Affect Schedule, and Beck Depression Inventory. Logistic regression analyses were conducted to assess the risk of discontinuing the study. The analyses were adjusted for sex, age, study group, and educational status. RESULTS At the 3-month follow-up, 65 of 89 participants (73% of the initial sample) had continued in the study. Participants' personality characteristics and indicators of psychological well-being were not associated with the risk of dropping out of the study (all P values >.05). The results remained the same after covariate controls. CONCLUSIONS Participant attrition was not attributable to personality characteristics or psychological well-being in the Motivation Makes the Move! study conducted with overweight adults. As attrition remains a challenge within longitudinal, technology-supported lifestyle interventions, attention should be paid to the potentially dynamic natures of personality and psychological well-being, as well as other elements beyond these. TRIAL REGISTRATION ClinicalTrials.gov NCT02686502; https://clinicaltrials.gov/ct2/show/NCT02686502.
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Affiliation(s)
- Kaisa Kaseva
- Department of Sport and Exercise Medicine, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Cicero Learning, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Mari Tervaniemi
- Cicero Learning, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Enni Heikura
- Cicero Learning, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kaisamari Kostilainen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maritta Pöyhönen-Alho
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Kevin Shoemaker
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, ON, Canada
| | - Robert J Petrella
- Division of Sport and Exercise Medicine, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Center for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Juha E Peltonen
- Department of Sport and Exercise Medicine, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Clinic for Sports and Exercise Medicine, Foundation for Sports and Exercise Medicine, Helsinki, Finland
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Ciprić A, Hald GM, Strizzi JM, Lange T, Austin D, Sander S, Øverup CS. The future of divorce support: Is "digital" enough in presence of conflict? JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:1128-1146. [PMID: 35288952 PMCID: PMC9790432 DOI: 10.1111/jmft.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/01/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
Divorce conflict is the main driver of adverse postdivorce health adjustments among divorcing families. Despite the growing potential of online divorce support programs, there is concern that such solutions might not be sufficient to impact health-related disparities among high-conflict divorcees. The present study examined the effectiveness of the digital "Cooperation after Divorce" intervention as a function of conflict among 1856 recently divorced Danish residents. Linear mixed-effect regression modeling suggested that, although higher levels of divorce conflict at judicial divorce predicted worse health outcomes up to 1 year following divorce, the effectiveness of the digital divorce intervention did not vary as a function of the initial level of divorce conflict. Individuals in the intervention group with higher conflict in divorce still reported worse health at 12 months follow-up than those with lower levels of divorce conflict; however, much lower than the control group.
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Affiliation(s)
- Ana Ciprić
- Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Gert Martin Hald
- Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jenna Marie Strizzi
- Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Theis Lange
- Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - David Austin
- School of Psychology, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
| | - Søren Sander
- Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Camilla Stine Øverup
- Department of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Barrera AZ, Morris SY, Ruiz A. Mothers and Babies Online Course: Participant Characteristics and Behaviors in a Web-Based Prevention of Postpartum Depression Intervention. Front Glob Womens Health 2022; 3:846611. [PMID: 35814836 PMCID: PMC9263388 DOI: 10.3389/fgwh.2022.846611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the availability of evidence-based postpartum depression (PPD) prevention and treatment interventions, perinatal persons continue to suffer. eHealth and mHealth tools to address mental health issues have grown exponentially, especially given the ubiquity of technology and the increased demand for telemental health resources. The Mothers and Babies Online Course (eMB), an 8-lesson prevention of PPD intervention, was digitally adapted to expand the reach of evidence-based interventions to perinatal persons with limited access to maternal mental health resources. This report describes the characteristics, behaviors, and feedback provided by users of the updated eMB website. Two hundred eight predominantly English-speaking U.S. residents enrolled in the eMB. Thirty-seven percent were either pregnant (n = 38) or postpartum (n = 39) women interested in learning skills to manage changes in their mood during and after pregnancy; 63% were health providers (n = 131) interested in learning how to support their patient communities. Seventy-six percent (n = 159) viewed at least one of the eight eMB lessons, with 50.9% exclusively viewing Lesson 1. Few (4.4%) viewed all eight lessons. The lessons were rated favorably on usefulness and understanding. Perinatal women engaged with interactive content at higher rates than health providers. Examining user behaviors and feedback is an essential developmental step before empirically testing the efficacy of digital tools. Future iterations of the eMB will incorporate these preliminary findings to provide perinatal persons with accessible web-based interventions that will hopefully reduce the incidence and negative consequences of postpartum depression.
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Ziadni MS, You DS, Keane R, Salazar B, Jaros S, Ram J, Roy A, Tanner N, Salmasi V, Gardner M, Darnall BD. "My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial. Anesth Analg 2022; 135:394-405. [PMID: 35696706 PMCID: PMC9259046 DOI: 10.1213/ane.0000000000006088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND: Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery. METHODS: A randomized controlled clinical trial was conducted at an orthopedic trauma surgery unit at a major academic hospital to compare a digital behavioral pain management intervention (“My Surgical Success” [MSS]) to a digital general health education (HE) intervention (HE; no pain management skills). The enrolled sample included 133 patients; 84 patients were randomized (MSS, n = 37; HE, n = 47) and completed study procedures. Most patients received their assigned intervention within 3 days of surgery (85%). The sample was predominantly male (61.5%), White (61.9%), and partnered (65.5%), with at least a bachelor’s degree (69.0%). Outcomes were collected at 1–3 months after intervention through self-report e-surveys and electronic medical record review; an intention-to-treat analytic framework was applied. Feasibility was dually determined by the proportion of patients engaging in their assigned treatment and an application of an 80% threshold for patient-reported acceptability. We hypothesized that MSS would result in greater reductions in pain intensity and pain catastrophizing after surgery and earlier opioid cessation compared to the digital HE control group. RESULTS: The engagement rate with assigned interventions was 63% and exceeded commonly reported rates for fully automated Internet-based e-health interventions. Feasibility was demonstrated for the MSS engagers, with >80% reporting treatment acceptability. Overall, both groups improved in the postsurgical months across all study variables. A significant interaction effect was found for treatment group over time on pain intensity, such that the MSS group evidenced greater absolute reductions in pain intensity after surgery and up to 3 months later (treatment × time fixed effects; F[215] = 5.23; P = .024). No statistically significant between-group differences were observed for time to opioid cessation or for reductions in pain catastrophizing (F[215] = 0.20; P = .653), although the study sample notably had subclinical baseline pain catastrophizing scores (M = 14.10; 95% confidence interval, 11.70–16.49). CONCLUSIONS: Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.
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Affiliation(s)
- Maisa S Ziadni
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Dokyoung S You
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ryan Keane
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Brett Salazar
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service
| | - Sam Jaros
- Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California
| | - Jesmin Ram
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Anuradha Roy
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Natalie Tanner
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service
| | - Vafi Salmasi
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Michael Gardner
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service
| | - Beth D Darnall
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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Maenhout L, Peuters C, Cardon G, Crombez G, DeSmet A, Compernolle S. Nonusage Attrition of Adolescents in an mHealth Promotion Intervention and the Role of Socioeconomic Status: Secondary Analysis of a 2-Arm Cluster-Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e36404. [PMID: 35536640 PMCID: PMC9131163 DOI: 10.2196/36404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mobile health (mHealth) interventions may help adolescents adopt healthy lifestyles. However, attrition in these interventions is high. Overall, there is a lack of research on nonusage attrition in adolescents, particularly regarding the role of socioeconomic status (SES). Objective The aim of this study was to focus on the role of SES in the following three research questions (RQs): When do adolescents stop using an mHealth intervention (RQ1)? Why do they report nonusage attrition (RQ2)? Which intervention components (ie, self-regulation component, narrative, and chatbot) prevent nonusage attrition among adolescents (RQ3)? Methods A total of 186 Flemish adolescents (aged 12-15 years) participated in a 12-week mHealth program. Log data were monitored to measure nonusage attrition and usage duration for the 3 intervention components. A web-based questionnaire was administered to assess reasons for attrition. A survival analysis was conducted to estimate the time to attrition and determine whether this differed according to SES (RQ1). Descriptive statistics were performed to map the attrition reasons, and Fisher exact tests were used to determine if these reasons differed depending on the educational track (RQ2). Mixed effects Cox proportional hazard regression models were used to estimate the associations between the use duration of the 3 components during the first week and attrition. An interaction term was added to the regression models to determine whether associations differed by the educational track (RQ3). Results After 12 weeks, 95.7% (178/186) of the participants stopped using the app. 30.1% (56/186) of the adolescents only opened the app on the installation day, and 44.1% (82/186) stopped using the app in the first week. Attrition at any given time during the intervention period was higher for adolescents from the nonacademic educational track compared with those from the academic track. The other SES indicators (family affluence and perceived financial situation) did not explain attrition. The most common reasons for nonusage attrition among participants were perceiving that the app did not lead to behavior change, not liking the app, thinking that they already had a sufficiently healthy lifestyle, using other apps, and not being motivated by the environment. Attrition reasons did not differ depending on the educational track. More time spent in the self-regulation and narrative components during the first week was associated with lower attrition, whereas chatbot use duration was not associated with attrition rates. No moderating effects of SES were observed in the latter association. Conclusions Nonusage attrition was high, especially among adolescents in the nonacademic educational track. The reported reasons for attrition were diverse, with no statistical differences according to the educational level. The duration of the use of the self-regulation and narrative components during the first week may prevent attrition for both educational tracks. Trial Registration ClinicalTrials.gov NCT04719858; http://clinicaltrials.gov/ct2/show/NCT04719858
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Affiliation(s)
- Laura Maenhout
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Carmen Peuters
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Ann DeSmet
- Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Sofie Compernolle
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
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11
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Ögmundsdóttir Michelsen H, Sjölin I, Bäck M, Gonzalez Garcia M, Olsson A, Sandberg C, Schiopu A, Leósdóttir M. Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial. J Med Internet Res 2022; 24:e25224. [PMID: 35357316 PMCID: PMC9015765 DOI: 10.2196/25224] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/09/2021] [Accepted: 12/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. OBJECTIVE This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). METHODS All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. RESULTS There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic -27.7 vs -16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic -25.3 vs -16.4 mm Hg; P=.02, and diastolic -13.4 vs -9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25. CONCLUSIONS Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-018-3118-1.
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Affiliation(s)
- Halldóra Ögmundsdóttir Michelsen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Ingela Sjölin
- Department of Cardiology, Skane University Hospital, Malmö, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Manuel Gonzalez Garcia
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Anneli Olsson
- Department of Cardiology, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Camilla Sandberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skane University Hospital, Lund, Sweden
| | - Margrét Leósdóttir
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Cardiology, Skane University Hospital, Malmö, Sweden
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12
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Silang KA, Sohal PR, Bright KS, Leason J, Roos L, Lebel C, Giesbrecht GF, Tomfohr-Madsen LM. eHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis. JMIR Ment Health 2022; 9:e31116. [PMID: 35188471 PMCID: PMC8902665 DOI: 10.2196/31116] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. OBJECTIVE The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. METHODS A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. RESULTS In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. CONCLUSIONS eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954.
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Affiliation(s)
| | - Pooja R Sohal
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Katherine S Bright
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Women's Mental Health Clinic, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Jennifer Leason
- Department of Anthropology and Archaeology, University of Calgary, Calgary, AB, Canada
| | - Leslie Roos
- Department of Psychology and Pediatrics, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Catherine Lebel
- Department of Radiology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Gerald F Giesbrecht
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
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13
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Øverup CS, Cipric A, Strizzi JM, Sander S, Hald GM. Temporal Associations between Depression and Hostility in the Context of a Divorce Intervention. Psychol Rep 2022; 126:1339-1361. [PMID: 35084249 DOI: 10.1177/00332941211070212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Divorce interventions have been found effective in reducing negative outcomes for newly divorced people, including depression and hostility. Typically, divorce interventions cover a variety of issues that may influence people's level of depression and hostility. However, it is unclear whether the interventions differentially affect the outcomes. That is, it may be that intervention participation leads to a reduction in depression, which is associated with a prospective reduction in hostility - or vice versa. The current study used a sample of 1,856 recently divorced Danes, who completed questionnaires at baseline, 3-, 6-, and 12-month post-divorce. Structural equation modeling revealed that while depression and hostility were concurrently associated, there were no prospective associations, except for baseline depression predicting 3-month hostility. Moreover, the associations did not differ by gender. The results suggest that the intervention content may have influenced both depression and hostility. These findings may be useful in guiding future divorce intervention developments.
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Affiliation(s)
| | - Ana Cipric
- Department of Public Health4321Kobenhavns Universitet
| | | | - Søren Sander
- Department of Public Health4321Kobenhavns Universitet
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14
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Marrie RA, Cutter GR, Fox RJ, Vollmer T, Tyry T, Salter A. NARCOMS and Other Registries in Multiple Sclerosis: Issues and Insights. Int J MS Care 2021; 23:276-284. [PMID: 35035299 PMCID: PMC8745235 DOI: 10.7224/1537-2073.2020-133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Observational studies and registries can play a critical role in elucidating the natural and treated history of multiple sclerosis (MS) and identifying factors associated with outcomes such as disability and health-related quality of life. The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry is one of multiple registries worldwide that focuses on people with MS, but one of the very few patient-driven MS registries. On the 25th anniversary of the first data collection for the NARCOMS Registry, we discuss the importance of disease registries in the MS field, describe key concepts related to registry design and management, and highlight findings from MS registries relevant to clinical care or health policy.
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Affiliation(s)
- Ruth Ann Marrie
- From the Department of Internal Medicine and Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada (RAM)
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA (GRC)
| | - Robert J. Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (RJF)
| | - Timothy Vollmer
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus, University of Colorado Denver, Denver, CO, USA (TV)
| | | | - Amber Salter
- Division of Biostatistics, Washington University in St Louis, St Louis, MO, USA (AS [now at UT Southwestern Medical Center])
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15
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Silang K, Sanguino H, Sohal PR, Rioux C, Kim HS, Tomfohr-Madsen LM. eHealth Interventions to Treat Substance Use in Pregnancy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9952. [PMID: 34639252 PMCID: PMC8507611 DOI: 10.3390/ijerph18199952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023]
Abstract
Substance use during pregnancy is associated with adverse pregnancy and neonatal outcomes; eHealth interventions offer a potential accessible treatment option. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of eHealth interventions for the treatment of substance use during pregnancy. A comprehensive search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from May 2020 to April 2021. The protocol for this study was registered with Prospero (CRD42020205186) through the University of York Centre for Reviews and Dissemination. Two independent reviewers completed screening, data extraction, and quality assessment. RCTs were included if they reported: (a) administration of an eHealth intervention for (b) substance use outcomes, among (c) pregnant individuals. Comprehensive Meta-Analysis Software (CMA) was used to calculate pooled effect sizes (Odds Ratio) to determine the effect of eHealth interventions on substance use outcomes. Six studies were identified with substance use outcomes that included: smoking (n = 3), alcohol (n = 2), and other (n = 1). eHealth interventions were delivered through the internet (n = 1), computer (n = 3), telephone (n = 1), and text (n = 1). Results suggested that eHealth interventions significantly reduced substance use in pregnant individuals compared to controls (OR = 1.33, 95% CI = 1.06 to 1.65, p = 0.013). eHealth interventions offer a promising and accessible treatment option to reduce substance use during pregnancy. This work was supported by the generous donors of the Alberta Children's Hospital Foundation, the Canadian Child Health Clinician Scientist Program (CCHCSP), the Canadian Institute of Health Research and the Fonds de Recherche du Québec-Santé.
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Affiliation(s)
- Katherine Silang
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
| | - Hangsel Sanguino
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
| | - Pooja R. Sohal
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
| | - Charlie Rioux
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX 79409, USA;
| | - Hyoun S. Kim
- Department of Psychology, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Lianne M. Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB T3B 6A8, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada
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16
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Ziadni MS, Gonzalez-Castro L, Anderson S, Krishnamurthy P, Darnall BD. Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic. J Med Internet Res 2021; 23:e29672. [PMID: 34505832 PMCID: PMC8463950 DOI: 10.2196/29672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy-pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas. OBJECTIVE The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment. METHODS We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%). RESULTS Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS -8.72, 42.25% reduction; WLC: PCS -2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. CONCLUSIONS Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. TRIAL REGISTRATION ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Lluvia Gonzalez-Castro
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Steven Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Profit J, Adair KC, Cui X, Mitchell B, Brandon D, Tawfik DS, Rigdon J, Gould JB, Lee HC, Timpson WL, McCaffrey MJ, Davis AS, Pammi M, Matthews M, Stark AR, Papile LA, Thomas E, Cotten M, Khan A, Sexton JB. Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout. J Perinatol 2021; 41:2225-2234. [PMID: 34366432 PMCID: PMC8440181 DOI: 10.1038/s41372-021-01100-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. DESIGN RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. RESULTS Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95%CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months. CONCLUSION WISER appears to durably improve HCW well-being. CLINICAL TRIALS NUMBER NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.
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Affiliation(s)
- Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Kathryn C Adair
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Xin Cui
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Briana Mitchell
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Debra Brandon
- Duke University School of Nursing, Durham, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, USA
| | - Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeffrey B Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Henry C Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Wendy L Timpson
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martin J McCaffrey
- Division of Neonatal-Perinatal Medicine, University of North Carolina Chapel Hill School of Medicine and University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Mohan Pammi
- Section of Neonatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Melissa Matthews
- Department of Pediatrics-Neonatology, The University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Ann R Stark
- Department of Pediatrics, Division of Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Lu-Ann Papile
- Division of Neonatology, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Eric Thomas
- Department of Internal Medicine, The University of Texas Health Science Center and Memorial Hermann Medical Center, Houston, TX, USA
| | - Michael Cotten
- Division of Pediatrics-Neonatology, Duke University School of Medicine and Duke University Hospital, Durham, NC, USA
| | - Amir Khan
- Division of Neonatology, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA.
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Goldstein SP, Brick LA, Thomas JG, Forman EM. Examination of the relationship between lapses and weight loss in a smartphone-based just-in time adaptive intervention. Transl Behav Med 2021; 11:993-1005. [PMID: 33902112 DOI: 10.1093/tbm/ibaa097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We developed a smartphone-based just-in-time adaptive intervention (JITAI), called OnTrack, that provides personalized intervention to prevent dietary lapses (i.e., nonadherence from the behavioral weight loss intervention diet). OnTrack utilizes ecological momentary assessment (EMA; repeated electronic surveys) for self-reporting lapse triggers, predicts lapses using machine learning, and provides brief intervention to prevent lapse. We have established preliminary feasibility, acceptability, and efficacy of OnTrack, but no study has examined our hypothesized mechanism of action: reduced lapse frequency will be associated with greater weight loss while using OnTrack. This secondary analysis investigated the association between lapse frequency and the weekly percentage of weight loss. Post hoc analyses evaluated the moderating effect of OnTrack engagement on this association. Participants (N = 121) with overweight/obesity (MBMI = 34.51; 84.3% female; 69.4% White) used OnTrack with a digital weight loss program for 10 weeks. Engagement with OnTrack (i.e., EMA completed and interventions accessed) was recorded automatically, participants self-reported dietary lapses via EMA, and weighed weekly using Bluetooth scales. Linear mixed models with a random effect of subject and fixed effect of time revealed a nonsignificant association between weekly lapses and the percentage of weight loss. Post hoc analyses revealed a statistically significant moderation effect of OnTrack engagement such that fewer EMA and interventions completed conferred the expected associations between lapses and weight loss. Lapses were not associated with weight loss in this study and one explanation may be the influence of engagement levels on this relationship. Future research should investigate the role of engagement in evaluating JITAIs.
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Affiliation(s)
- Stephanie P Goldstein
- The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Graham Thomas
- The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, PA, USA
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19
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Choi I, Ho N, Morris R, Harvey SB, Calvo RA, Glozier N. The impact of communicating personal mental ill-health risk: A randomized controlled non-inferiority trial. Early Interv Psychiatry 2021; 15:932-941. [PMID: 32930513 DOI: 10.1111/eip.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/22/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022]
Abstract
AIM Risk algorithms predicting personal mental ill-health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill-health risk profiles on psychological distress. METHODS Australian participants using a mood-monitoring app were randomly allocated to receiving their current personal mental ill-health risk profile (n = 119), their achievable personal risk profile (n = 118) or to a control group (n = 118) in which no risk information was communicated, in a non-inferiority trial design. The primary outcome was psychological distress at four-weeks as assessed on the Kessler Psychological Distress Scale. RESULTS There was high attrition in the trial with 64% of data missing at follow up. Per-protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m = 0.19, 95% CI: -2.59- 2.98) and achievable risk (m = -0.09, 95% CI: -2.84 to 2.66) groups were within the non-inferiority margin of the control group's mean at follow up. Supplementary intention-to-treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non-inferiority to the control group. CONCLUSIONS This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.
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Affiliation(s)
- Isabella Choi
- Central Clinical School, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Ho
- Central Clinical School, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Morris
- Central Clinical School, Faculty of Medicine and Health, Centre for Translational Data Science, University of Sydney, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rafael A Calvo
- Faculty of Engineering, Dyson School of Design Engineering, Imperial College London, London, UK
| | - Nicholas Glozier
- Central Clinical School, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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20
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Meijer E, Korst JS, Oosting KG, Heemskerk E, Hermsen S, Willemsen MC, van den Putte B, Chavannes NH, Brown J. "At least someone thinks I'm doing well": a real-world evaluation of the quit-smoking app StopCoach for lower socio-economic status smokers. Addict Sci Clin Pract 2021; 16:48. [PMID: 34321088 PMCID: PMC8320182 DOI: 10.1186/s13722-021-00255-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking is more prevalent and persistent among lower socio-economic status (SES) compared with higher-SES groups, and contributes greatly to SES-based health inequities. Few interventions exist that effectively help lower-SES smokers quit. This study evaluated "De StopCoach", a mobile phone delivered eHealth intervention targeted at lower-SES smokers based on the evidence-based StopAdvisor, in a real-world setting (five municipalities) in The Netherlands in 2019-2020. METHOD We conducted individual semi-structured interviews with project leaders, healthcare professionals, and participating smokers (N = 22), and examined log data from the app (N = 235). For practical reasons, SES of app users was not measured. Qualitative data were analysed using the Framework Approach, with the Consolidated Framework for Implementation Research (CFIR) and Unified Theory of Acceptance and Use of Technology (UTAUT) as theoretical models. RESULTS Qualitative data showed that factors from the Intervention and Setting domains were most important for the implementation. StopCoach seemed suitable for lower-SES smokers in terms of performance and effort expectancy, especially when integrated with regular smoking cessation counseling (SCC). Key barriers to implementation of the app were limited integration of the app in SCC programs in practice, difficulty experienced by project leaders and healthcare professionals to engage the local community, and barriers to SCC more generally (e.g., perceived resistance to quitting in patients) that prevented healthcare professionals from offering the app to smokers. Quantitative data showed that 48% of app users continued using the app after the preparation phase and pre-quit day, and that 33% of app users had attempted to quit. Both app adherence and quit attempts were more likely if smokers also received SCC from a professional coach. Posthoc analyses suggest that adherence is related to higher likelihood of a quit attempt among participants with and without a professional coach. CONCLUSIONS Smokers, healthcare professionals and project leaders indicated in the interviews that the StopCoach app would work best when combined with SCC. It also appears from app log that app adherence and quit attempts by app users can be facilitated by combining the app with face-to-face SCC. As such, blended care appears promising for helping individual smokers quit, as it combines the best of regular SCC and eHealth. Further research on blended care for lower-SES smokers is needed.
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Affiliation(s)
- Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Janneke S. Korst
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Kristiene G. Oosting
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Heemskerk
- Pharos Dutch Center of Expertise On Health Disparities, Utrecht, The Netherlands
| | - Sander Hermsen
- OnePlanet Research Center, Imec NL, Wageningen, The Netherlands
| | - Marc C. Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels H. Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Collaboration, London, UK
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21
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Rullo JE, Sood R, Fokken SC, Sood A, Frohmader KS, Croghan IT, Schroeder DR, Faubion SS. Couples' Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial. Sex Med 2021; 9:100404. [PMID: 34280591 PMCID: PMC8360907 DOI: 10.1016/j.esxm.2021.100404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction Mindfulness is a promising intervention for female sexual dysfunction (FSD); however, of the mindfulness interventions studied, few treat the woman and her partner. Aim We developed a brief online mindfulness, resilience, and psychoeducation intervention, Stress Management and Resiliency Training for Sexuality (Sex SMART), for women with sexual health concerns and their partners. Methods Women with female sexual interest/arousal disorder and their partners were recruited between February 24, 2015, and October 6, 2016, and randomized to treatment or control groups (received educational pamphlets). The treatment intervention comprised of an online SMART and sexual health psychoeducation module. Main Outcome Measures The Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Sexual Desire Inventory-2 (SDI-2), Revised Dyadic Adjustment Scale (RDAS), International Index of Erectile Function (IIEF), and other subjective measures were used to assess sexual function and sexual distress at baseline and 12 weeks. Results The study included 60 women and their partners (30 couples in each group). In both groups, sexual function by total FSFI scores and sexual distress scores significantly improved at 12 weeks compared with baseline, with no significant between-group differences (FSFI effect estimate for Sex SMART vs control = +1.4 (90% CI [–0.6 to +3.4]; P=.13). Both participants and partners randomized to the intervention reported significantly improved attitude and feelings, comfort as a sexual person, and subjective sexual functioning at 12 weeks. The findings provide preliminary evidence for efficacy of an online intervention for couples with sexual health problems. Conclusions A brief online mindfulness, resilience, and psychoeducation–based intervention showed no significant improvement in many outcomes (FSFI, FSDS-R, SDI-2, RDAS) of sexual health versus controls. Although this is the first online randomized controlled trial to evaluate a mindfulness-based therapy intervention, it was limited by its lack of population diversity and high attrition rate. Significant improvements in subjective sexual health and partner sexual function by the International Index of Erectile Function were reported only in the intervention group. Rullo JE, Sood R, Fokken SC, et al. Couples’ Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial. Sex Med 2021;9:100404.
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Affiliation(s)
- Jordan E Rullo
- Menopause and Women's Sexual Health Clinic, Rochester, Minnesota; Department of Clinical Psychology, The University of Utah, Salt Lake City, Utah.
| | - Richa Sood
- Menopause and Women's Sexual Health Clinic, Rochester, Minnesota; Center for Women's Health, Rochester, Minnesota
| | - Shawn C Fokken
- Division of General Internal Medicine, Rochester, Minnesota
| | - Amit Sood
- Viterbo University, La Crosse, Wisconsin
| | | | - Ivana T Croghan
- Division of General Internal Medicine, Rochester, Minnesota; Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie S Faubion
- Center for Women's Health, Rochester, Minnesota; Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida
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22
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Davison CM, Bartels SA, Purkey E, Neely AH, Bisung E, Collier A, Dutton S, Aldersey HM, Hoyt K, Kivland CL, Carpenter J, Talbot EA, Adams LV. Last mile research: a conceptual map. Glob Health Action 2021; 14:1893026. [PMID: 33736574 PMCID: PMC8288767 DOI: 10.1080/16549716.2021.1893026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization.Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile?Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting.Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity.Conclusion: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight.
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Affiliation(s)
- Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Susan A Bartels
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Eva Purkey
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Abigail H Neely
- Department of Geography, Dartmouth College, Hanover, New Hampshire, USA
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sherri Dutton
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Heather M Aldersey
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kendall Hoyt
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Chelsey L Kivland
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Jennifer Carpenter
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elizabeth A Talbot
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Lisa V Adams
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.,Center for Global Health Equity, Dartmouth College, Hanover, New Hampshire, USA
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23
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Young CL, Mohebbi M, Staudacher H, Berk M, Jacka FN, O'Neil A. Assessing the feasibility of an m-Health intervention for changing diet quality and mood in individuals with depression: the My Food & Mood program. Int Rev Psychiatry 2021; 33:266-279. [PMID: 34039236 DOI: 10.1080/09540261.2020.1854193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent randomized controlled trials have shown that improving diet quality reduces symptoms in those with depression. The provision of digital health interventions that can support dietary change in those with depression has important benefits with respect to reach, accessibility convenience and cost. The My Food & Mood study used single arm cohort design to test the feasibility of such an intervention. Participants with current depressive symptoms were recruited and enrolled online to use the My Food & Mood m-Health (smartphone delivered) program for 8 weeks. Participants completed depression (PHQ-8) and dietary questionnaires (MEDAS) at baseline, week 4 and week 8. Metrics of use and intensity of use engagement measures were calculated from system logs and data entries. There was a significant change in both MEDAS score (t = 8.147, df = 44, p < 0.001) and PHQ-8 score (t = -7.199, df = 44, p < 0.001) throughout the study. There was a moderate positive association between change in MEDAS score and activities completed, goals and weeks engaged, and a strong inverse association between change in MEDAS score and change in PHQ-8 score. An m-Health program targeting dietary intervention in those with depression was feasible. Dietary change was associated with higher engagement and reduced depressive symptoms.
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Affiliation(s)
- Claire L Young
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Heidi Staudacher
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Felice N Jacka
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Black Dog Institute, Randwick, NSW, Australia.,James Cook University, Townsville, QLD, Australia
| | - Adrienne O'Neil
- Food & Mood Centre, IIMPACT (the Institute for Mental and Physical Health and Clinical Translation), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
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24
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Young CL, Mohebbi M, Staudacher HM, Kay-Lambkin F, Berk M, Jacka FN, O'Neil A. Optimizing Engagement in an Online Dietary Intervention for Depression (My Food & Mood Version 3.0): Cohort Study. JMIR Ment Health 2021; 8:e24871. [PMID: 33787501 PMCID: PMC8047812 DOI: 10.2196/24871] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/28/2020] [Accepted: 01/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Online interventions can be a cost-effective and efficient way to deliver programs to large numbers of people regardless of geographic location. However, attrition in web-based interventions is often an issue. Developing ways to keep participants engaged is important for ensuring validity and limiting potential biases. We developed a web-based dietary intervention as part of The My Food & Mood study which aimed to optimize ways to engage participants with low mood or depressive symptoms to promote dietary behavior change. Different versions of the My Food & Mood program were tested during optimization. Iterations were developed based on user feedback and usage analysis. OBJECTIVE The purpose of this study was to compare engagement and nonusage attrition across 4 program iterations-which differed by platform format, delivery mode, and activity type-to create an optimized version. METHODS Each program version contained modular videos with key activities with respect to implementing behavior change techniques of equivalent levels of required participation and length: version 1.0, desktop program and smartphone app; version 2.1, desktop or smartphone program; version 2.2, desktop program; and version 3.0, smartphone app. Adults with PHQ-8 scores of 5 or greater were recruited online and assigned to 1 of the 4 versions. Participants were asked to use the program for 8 weeks and complete measures at weeks 4 and 8. Engagement data were collected from the web-based platform system logs and customized reports. Cox regression survival analysis examined nonusage attrition and Kruskal-Wallis tests compared engagement across each cohort. RESULTS A total of 614 adults participated. Kruskal-Wallis tests showed significant differences across the 4 cohorts in all engagement measures. The smartphone app (version 3.0) had the greatest engagement as measured by weeks engaged, total usage time, total time key activities, number of active sessions, percentage of activities completed against protocol, goals completed, and percentage of videos watched. Cox regression multivariate survival analysis showed referral from a health practitioner (hazard ratio [HR] 0.344, P=.001) and greater proficiency with computers (HR 0.796, P=.049) reduced the risk of nonusage attrition. Computer confidence was associated with an increased risk of nonusage attrition. CONCLUSIONS My Food & Mood version 3.0, a dietary intervention delivered via smartphone app with self-monitoring tools for diet quality and mood monitoring, was the version with greatest engagement in a population with low mood or depression. The iterative design techniques employed and analysis of feedback from participants resulted in a program that achieved lower rates of nonusage attrition and higher rates of intensity of use.
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Affiliation(s)
- Claire Louise Young
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | | | - Heidi M Staudacher
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Felice Nellie Jacka
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Black Dog Institute, Syndey, New South Wales, Australia
- James Cook University, Queensland, Australia
| | - Adrienne O'Neil
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
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25
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Loo Gee B, Batterham PJ, Gulliver A, Reynolds J, Griffiths KM. An Ecological Momentary Intervention for people with social anxiety: A descriptive case study. Inform Health Soc Care 2021; 46:370-398. [PMID: 33779480 DOI: 10.1080/17538157.2021.1896525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study describes the development and pilot evaluation of a smartphone- delivered Ecological Momentary Intervention (EMI) for people with social anxiety symptoms. Using a software engineering framework (agile modeling, model-driven development, bottom-up development), mental health experts and software developers collaborated to develop a 4-module EMI app designed to reduce social anxiety in real-time. Fifty-five participants with social anxiety were randomly allocated to the EMI or a wait-list control arm. App downloads, usage and user satisfaction data were collected and mental health outcomes assessed at baseline and post-intervention. Software development practices allowed mental health experts to distil core elements of a psychological intervention into discrete software components but there were challenges in engaging mental health experts in the process. Relative to control there was no significant reduction in social anxiety among the EMI participants in the pilot trial. However, post-test data were available for only 4 intervention and 10 control participants and only 2 (4.0%) of the EMI participants downloaded the app. The two participants who both accessed the app and completed the post-test reported being satisfied with the intervention. Future research should address managing resources and providing additional training to support ongoing engagement with key stakeholders.
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Affiliation(s)
- Brendan Loo Gee
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra ACT, Australia
| | - Julia Reynolds
- Research School of Psychology, The Australian National University, Canberra ACT, Australia
| | - Kathleen M Griffiths
- Research School of Psychology, The Australian National University, Canberra ACT, Australia
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26
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Goodmann DR, Daouk S, Sullivan M, Cabrera J, Liu NH, Barakat S, Muñoz RF, Leykin Y. Factor analysis of depression symptoms across five broad cultural groups. J Affect Disord 2021; 282:227-235. [PMID: 33418371 DOI: 10.1016/j.jad.2020.12.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/24/2020] [Accepted: 12/24/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Core symptoms of depression are likely universal, however cultural groups differ in their experience of the condition. The purpose of this study was to examine differences and similarities of depression symptom groupings between broad cultural groups. METHOD 6,982 adults took part in an online multilingual depression screening study, and completed an 18-item major depression screener. Participants were categorized into five broad cultural groups by language and country of residence: Spanish speakers from Latin America (n = 3,411); English speakers from Southeast Asia (n = 1,265); Russian speakers from the former Soviet bloc (n = 642); English speakers from English-speaking Western countries (n = 999); and Chinese speakers from China (n = 665). Principal components analysis with promax rotation was used. RESULTS Both similarities and noteworthy differences in symptom clustering between groups were observed. For instance, though suicide-related items formed a separate cluster for most cultures, for the Latin-American group, worthlessness loaded with suicidality. Changes in appetite and changes in weight tended to load on different factors (except for Chinese and Russian groups). Hypersomnia tended to load with psychomotor agitation, and core depression symptoms tended to load with physical symptoms (except for the Russian group). LIMITATIONS Depression was assessed by a self-report measure aligned to DSM-IV. CONCLUSION The analysis contributes to a nuanced understanding of depression manifestations of various cultures, which may inform culturally sensitive clinical practice.
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Affiliation(s)
- Danielle R Goodmann
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Sariah Daouk
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Megan Sullivan
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | | | | | | | - Ricardo F Muñoz
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States; University of California, San Francisco
| | - Yan Leykin
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States; University of California, San Francisco.
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27
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Garcia LM, Birckhead BJ, Krishnamurthy P, Sackman J, Mackey IG, Louis RG, Salmasi V, Maddox T, Darnall BD. An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19. J Med Internet Res 2021; 23:e26292. [PMID: 33484240 PMCID: PMC7939946 DOI: 10.2196/26292] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. OBJECTIVE We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. METHODS A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between-within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. RESULTS The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre-post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. CONCLUSIONS EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/25291.
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Affiliation(s)
| | | | | | | | | | - Robert G Louis
- Division of Neurosurgery, Pickup Family Neurosciences Institute, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Vafi Salmasi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Todd Maddox
- AppliedVR, Inc, Los Angeles, CA, United States
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Garcia LM, Darnall BD, Krishnamurthy P, Mackey IG, Sackman J, Louis RG, Maddox T, Birckhead BJ. Self-Administered Behavioral Skills-Based At-Home Virtual Reality Therapy for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25291. [PMID: 33464215 PMCID: PMC7854039 DOI: 10.2196/25291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Chronic pain is one of the most common and debilitating health conditions. Treatments for chronic low back pain typically focus on biomedical treatment approaches. While psychosocial treatments exist, multiple barriers prevent broad access. There is a significant unmet need for integrative, easily accessible, non-opioid solutions for chronic pain. Virtual reality (VR) is an immersive technology allowing innovation in the delivery of behavioral pain treatments. Behavioral skills-based VR is effective at facilitating pain management and reducing pain-related concerns. Continued research on these emerging approaches is needed. OBJECTIVE In this randomized controlled trial, we seek to test the efficacy of a self-administered behavioral skills-based VR program as a nonpharmacological home-based pain management treatment for people with chronic low back pain (cLBP). METHODS We will randomize 180 individuals with cLBP to 1 of 2 VR programs: (1) EaseVRx (8-week skills-based VR program); or (2) Sham VR (control condition). All participants will receive a VR headset to minimize any biases related to the technology's novelty. The Sham VR group had 2D neutral content in a 3D theater-like environment. Our primary outcome is average pain intensity and pain-related interference with activity, stress, mood, and sleep. Our secondary outcomes include patient-reported physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, health utilization, medication use, and user satisfaction. We hypothesize superiority for the skills-based VR program in all of these measures compared to the control condition. Team statisticians blinded to treatment assignment will assess outcomes up to 6 months posttreatment using an approach suitable for the longitudinal nature of the data. RESULTS The study was approved by the Western Institutional Review Board on July 2, 2020. The protocol (NCT04415177) was registered on May 27, 2020. Recruitment for this study was completed in July 2020, and data collection will remain active until March 2021. In total, 186 participants were recruited. Multiple manuscripts will be generated from this study. The primary manuscript will be submitted for publication in the winter of 2020. CONCLUSIONS Effectively delivering behavioral treatments in VR could overcome barriers to care and provide scalable solutions to chronic pain's societal burden. Our study could help shape future research and development of these innovative approaches. TRIAL REGISTRATION ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/25291.
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Affiliation(s)
- Laura M Garcia
- Research and Development, AppliedVR Inc, Los Angeles, CA, United States.,USC Creative Media and Behavioral Health Center, Los Angeles, CA, United States
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Ian G Mackey
- Research and Development, AppliedVR Inc, Los Angeles, CA, United States
| | - Josh Sackman
- Research and Development, AppliedVR Inc, Los Angeles, CA, United States
| | - Robert G Louis
- Division of Neurosurgery, Pickup Family Neurosciences Institute, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Todd Maddox
- Research and Development, AppliedVR Inc, Los Angeles, CA, United States
| | - Brandon J Birckhead
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States
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GONÇALVES MF, BEDENDO A, ANDRADE ALM, NOTO AR. Factors associated with adherence to a web-based alcohol intervention among college students. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2021. [DOI: 10.1590/1982-0275202138e190134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Abstract This study aimed to evaluate the association between student characteristics and recruitment strategies in the adherence of college students to a web-based alcohol intervention. Participants were 46,329 Brazilian students aged from 18 to 30, who consumed alcohol during the past three months. Three recruitment strategies were implemented: open invitations, and personally-addressed invitations with or without non-monetary incentives. We evaluated the educational, sociodemographic, motivational, and alcohol consumption effects on adherence using logistic regression models. Women (aOR = 1.09 [1.04; 1.14]), students with higher income (aOR = 1.32 [1.21; 1.45]), and more motivated students (aOR = 1.04 [1.03; 1.05]) were more adherent to the intervention, as well as those reporting binge drinking (aOR = 1.26 [1.19; 1.33]) and alcohol hazardous use (aOR = 1.11 [1.05; 1.18]). The use of incentives was the main factor associated with adherence (aOR = 3.69 [2.46; 5.55]). Our results may help the development of future web-based interventions related to alcohol use.
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Affiliation(s)
| | - André BEDENDO
- Universidade Federal de São Paulo, Brasil; University of York, United Kingdom
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Signal V, McLeod M, Stanley J, Stairmand J, Sukumaran N, Thompson DM, Henderson K, Davies C, Krebs J, Dowell A, Grainger R, Sarfati D. A Mobile- and Web-Based Health Intervention Program for Diabetes and Prediabetes Self-Management (BetaMe/Melon): Process Evaluation Following a Randomized Controlled Trial. J Med Internet Res 2020; 22:e19150. [PMID: 33258776 PMCID: PMC7738254 DOI: 10.2196/19150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Technology-assisted self-management programs are increasingly recommended to patients with long-term conditions such as diabetes. However, there are a number of personal and external factors that affect patients' abilities to engage with and effectively utilize such programs. A randomized controlled trial of a multi-modal online program for diabetes self-management (BetaMe/Melon) was conducted in a primary care setting, and a process evaluation was completed at the end of the study period. OBJECTIVE This process evaluation aimed to examine the utilization patterns of BetaMe/Melon, identify which components participants found most (and least) useful, and identify areas of future improvement. METHODS Process evaluation data were collected for intervention arm participants from 3 sources: (1) the mobile/web platform (to identify key usage patterns over the 16-week core program), (2) an online questionnaire completed during the final study assessment, and (3) interviews conducted with a subset of participants following the study period. Participants were classified as "actively engaged" if any usage data was recorded for the participant (in any week), and patterns were reported by age, gender, ethnicity, and diabetes/prediabetes status. The online questionnaire asked participants about the usefulness of the program and whether they would recommend BetaMe/Melon to others according to a 5-point Likert Scale. Of 23 invited participants, 18 participated in a digitally recorded, semistructured telephone interview. Interview data were thematically analyzed. RESULTS Out of the 215 participants, 198 (92%) received an initial health coaching session, and 160 (74%) were actively engaged with the program at some point during the 16-week core program. Engagement varied by demographic, with women, younger participants, and ethnic majority populations having higher rates of engagement. Usage steadily declined from 50% at Week 0 to 23% at Week 15. Participants ranked component usefulness as education resources (63.7%), health coaches (59.2%), goal tracking (48.8%), and online peer support (42.1%). Although 53% agreed that the program was easy to use, 64% would recommend the program to others. Interview participants found BetaMe/Melon useful overall, with most identifying beneficial outcomes such as increased knowledge, behavioral changes, and weight loss. Barriers to engagement were program functionality, internet connectivity, incomplete delivery of all program components, and participant motivation. Participants suggested a range of improvements to the BetaMe/Melon program. CONCLUSIONS The program was generally well received by participants; active engagement was initially high, although it declined steadily. Maintaining participant engagement over time, individualizing programs, and addressing technical barriers are important to maximize potential health benefits from online diabetes self-management programs. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12617000549325; https://tinyurl.com/y622b27q.
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Affiliation(s)
- Virginia Signal
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Melissa McLeod
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, Wellington, New Zealand
| | - Jeannine Stairmand
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nitin Sukumaran
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - Donna-Marie Thompson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Kelly Henderson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | | | - Jeremy Krebs
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Smith N, Liu S. A systematic review of the dose-response relationship between usage and outcomes of online physical activity weight-loss interventions. Internet Interv 2020; 22:100344. [PMID: 32995302 PMCID: PMC7516044 DOI: 10.1016/j.invent.2020.100344] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Online physical activity interventions can be an effective strategy for weight loss. However, there is a lack of systematic reviews examining the relationship between intervention usage (dose) and participants' response to online physical activity interventions for weight loss. It remains unclear whether certain usage metrics (e.g. login frequency, percent of content accessed) would be associated with improvements in behavioral outcomes. Understanding the dose-response relationship for online physical activity interventions for weight loss would be important for designing and evaluating future interventions. OBJECTIVE 1) Review the methods used to assess intervention usage and 2) to explore the association between intervention usage metrics and outcomes for online physical activity interventions for weight-loss. METHODS We conducted a systematic review following the PRISMA guidelines to examine the dose-response relationship of online-based interventions targeting physical activity. We used the following keywords: web OR internet OR online OR eHealth AND physical activity OR exercise, AND engagement OR dose OR dose-response OR usage AND obesity OR weight*. Peer-reviewed articles published between 2006 and 2019 were included. RESULTS A total of five articles met the inclusion criteria. The mean intervention length was 10 ± 6 months (range 2-30 months). The usage metrics were total number of logins, login frequency, and usage of online tools. All usage metrics reported were found to be related to outcomes in physical activity interventions for weight-loss. CONCLUSION Our findings suggest that usage metrics for online physical activity interventions for weight-loss included login frequency, login duration, and use of online tools. Increased intervention usage appeared to be associated with an improvement in participant's weight, physical activity behaviors, and intervention retention. Future research should examine innovative ways to maintain intervention usage throughout the intervention.
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Affiliation(s)
- Nicholas Smith
- School of Exercise Science, Physical and Health Education, University of Victoria, McKinnon Building, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, McKinnon Building, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
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Malliaras P, Cridland K, Hopmans R, Ashton S, Littlewood C, Page R, Harris I, Skouteris H, Haines T. Internet and Telerehabilitation-Delivered Management of Rotator Cuff-Related Shoulder Pain (INTEL Trial): Randomized Controlled Pilot and Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e24311. [PMID: 33206059 PMCID: PMC7710452 DOI: 10.2196/24311] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) is a common and disabling musculoskeletal condition. Internet-based and telerehabilitation delivery of recommended care may improve access to care and improve adherence and outcomes. OBJECTIVE The primary aim of this pilot randomized controlled trial was to assess the feasibility of a 12-week internet-delivered intervention for RCRSP comparing advice only, recommended care, and recommended care with group-based telerehabilitation. METHODS Reporting was in accordance with the Consolidated Standards of Reporting Trials (CONSORT) checklist for pilot and feasibility trials. People with a primary complaint of RCRSP for 3 months or longer were identified via a paid Facebook strategy. Screening involved an online questionnaire followed by a 20-minute telehealth assessment. Participants were randomly allocated (via a Zelen design) to receive (1) advice only, (2) recommended care (internet-delivered evidence-based exercise and education), or (3) recommended care and telerehabilitation (including a weekly group teleconference session). Progression criteria for a full-scale trial included (1) recruitment of 20% or greater of eligible participants, (2) acceptable adherence (two or more of the three prescribed weekly sessions) among 70% or greater of participants, (3) 80% or greater retention of participants, (4) absence of intervention-related serious adverse events, and (5) 80% or greater response rates to questionnaires. Secondary clinical and patient knowledge outcomes were collected (via email or text) at baseline, six weeks, and 12 weeks (for clinical and patient knowledge), and within-group change was reported descriptively. RESULTS We enrolled 36 of 38 (95%) eligible participants and all participants were recruited within a 3-week period. Of the 36 participants, 12 participants were allocated to each of the three trial arms. The mean age of participants was between 51 and 56 years, and 83% (10/12) to 92% (11/12) were female. Retention at the 12-week endpoint was 94% (34/36) and response to email questionnaires at other time points was 83% or greater. We found acceptable adherence (defined as greater than 70% of participants performing exercise 2 or 3 times/week) in the recommended care group with telerehabilitation but not in the recommended care group without telerehabilitation. There was a total of 24 adverse events over 108 person-months of observation. All adverse events were mild or moderate (mainly muscle and shoulder symptoms), with the exception of one instance of elective surgery (unrelated to the person's shoulder condition). CONCLUSIONS Our prespecified success criteria were met or exceeded, but there was a gender imbalance toward women. It is feasible to progress to a fully powered trial, but strategies to address the gender imbalance need to be implemented. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12620000248965); https://tinyurl.com/yy6eztf5.
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Affiliation(s)
- Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Kate Cridland
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ruben Hopmans
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Simon Ashton
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Chris Littlewood
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Page
- Barwon Orthopaedic Research and Education, Barwon Health and School of Medicine, Deakin University, Geelong, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Liverpool Hospital, Sydney, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
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Shah A, Chaiton M, Baliunas D, Schwartz R. Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e16255. [PMID: 33074158 PMCID: PMC7605982 DOI: 10.2196/16255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. Objective The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. Methods Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. Results A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I2=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I2=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I2=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I2=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25). Conclusions The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries.
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Affiliation(s)
- Amika Shah
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dolly Baliunas
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robert Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Schroé H, Van Dyck D, De Paepe A, Poppe L, Loh WW, Verloigne M, Loeys T, De Bourdeaudhuij I, Crombez G. Which behaviour change techniques are effective to promote physical activity and reduce sedentary behaviour in adults: a factorial randomized trial of an e- and m-health intervention. Int J Behav Nutr Phys Act 2020; 17:127. [PMID: 33028335 PMCID: PMC7539442 DOI: 10.1186/s12966-020-01001-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/22/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND E- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it's not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this experimental study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB) against a background set of other BCTs. METHODS In a 2 (action planning: present vs absent) × 2 (coping planning: present vs absent) × 2 (self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention 'MyPlan2.0' for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA (n = 335, age = 35.8, 28.1% men) or SB (n = 138, age = 37.8, 37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB. RESULTS First, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735, p = 0.007) and reduced SB (t = - 2.573, p = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302, p = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy. Using the combination of the three BCTs was most effective to increase PA (x2 = 8849, p = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x2 = 3.918, p = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x2 = 5.590, p = 0.014; x2 = 17.722, p < 0.001; x2 = 4.552, p = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x2 = 4.389, p = 0.031) and self-monitoring alone (x2 = 8.858, p = 003), respectively. CONCLUSIONS This study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future. TRIAL REGISTRATION This study was preregistered as a clinical trial (ID number: NCT03274271 ). Release date: 20 October 2017.
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Affiliation(s)
- Helene Schroé
- Ghent Health Psychology Lab, Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium. .,Research Group Physical Activity and Health, Department of Movement and Sports Sciences, Faculty of Medicine and Health, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Delfien Van Dyck
- Research Group Physical Activity and Health, Department of Movement and Sports Sciences, Faculty of Medicine and Health, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Annick De Paepe
- Ghent Health Psychology Lab, Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Louise Poppe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wen Wei Loh
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Maïté Verloigne
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tom Loeys
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Ilse De Bourdeaudhuij
- Research Group Physical Activity and Health, Department of Movement and Sports Sciences, Faculty of Medicine and Health, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Geert Crombez
- Ghent Health Psychology Lab, Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
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Darnall BD, Ziadni MS, Krishnamurthy P, Flood P, Heathcote LC, Mackey IG, Taub CJ, Wheeler A. "My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial. PAIN MEDICINE 2020; 20:2228-2237. [PMID: 31087093 PMCID: PMC6830264 DOI: 10.1093/pm/pnz094] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective This study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery. Design and Setting A randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA) comparing a digital behavioral pain medicine intervention (“My Surgical Success” [MSS]) with digital general health education (HE). Participants A convenience sample of 127 participants were randomized to treatment group. The analytic sample was 68 patients (N = 36 MSS, N = 32 HE). Main Outcomes The primary outcome was feasibility and acceptability of a digital behavioral pain medicine intervention (80% threshold for acceptability items). Secondary outcomes were pain catastrophizing, past seven-day average pain intensity, and time to opioid cessation after surgery for patients who initiated opioid use. Results The attrition rate for MSS intervention (44%) was notably higher than for HE controls (18%), but it was lower than typical attrition rates for e-health interventions (60–80%). Despite greater attrition for MSS, feasibility was demonstrated for the 56% of MSS engagers, and the 80% threshold for acceptability was met. We observed a floor effect for baseline pain catastrophizing, and no significant group differences were found for postsurgical pain catastrophizing or pain intensity. MSS was associated with 86% increased odds of opioid cessation within the 12-week study period relative to HE controls (hazard ratio = 1.86, 95% confidence interval = 1.12–3.10, P = 0.016). Conclusions Fifty-six percent of patients assigned to MSS engaged with the online platform and reported high satisfaction. MSS was associated with significantly accelerated opioid cessation after surgery (five-day difference) with no difference in pain report relative to controls. Perioperative digital behavioral pain medicine may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.
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Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Parthasarathy Krishnamurthy
- Department of Marketing and Entrepreneurship, CT Bauer College of Business, University of Houston, Houston, Texas
| | - Pamela Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ian G Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Chloe Jean Taub
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Amanda Wheeler
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Sander S, Hald GM, Cipric A, Øverup CS, Strizzi JM, Gad Kjeld S, Lange T. A Randomised Controlled Trial Study of the Effects of a Digital Divorce Platform on Mental and Physical Health. Appl Psychol Health Well Being 2020; 12:863-886. [PMID: 32767636 DOI: 10.1111/aphw.12213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Two decades of divorce research has consistently documented adverse mental and physical health effects of divorce. Responding to calls for evidence-based online divorce interventions, this study tests effects of the "Cooperation after Divorce" (CAD) digital intervention platform on divorcees' mental and physical health. METHODS Randomised control trial 12-month longitudinal study using a sample of 1,856 newly divorced Danes. Mental and physical health were measured using the SF-36 at baseline and 3, 6, and 12 months from baseline. Intervention effects were investigated using linear mixed effect models and Cohen's (d) for effect sizes. RESULTS The study found significant treatment effects of the CAD intervention on mental and physical health. These effects were evident across all eight health domains constituting the mental and physical health components. The study also found that the intervention group had significantly better mental health than the control group at subsequent 6- and 12-month assessments from baseline while for physical health, the intervention group had significantly better physical health at the 6-month assessment from baseline only. CONCLUSION The results indicate that digital solutions allowing for individually tailored user experiences may hold great potential in reducing well-known adverse health effects of divorce. PRACTITIONER'S POINTS The study finds highly significant treatment effects of the "CAD" digital divorce intervention on mental and physical health indicating that online interventions may be successfully integrated into help offered to divorcees post-divorce.
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Park JJ, Booth N, Bagot KL, Rodda SN. A brief internet-delivered intervention for the reduction of gaming-related harm: A feasibility study. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2020. [DOI: 10.1016/j.chbr.2020.100027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Willemse BJPC, Kaptein MC, Hasaart F. Developing Effective Methods for Electronic Health Personalization: Protocol for Health Telescope, a Prospective Interventional Study. JMIR Res Protoc 2020; 9:e16471. [PMID: 32734930 PMCID: PMC7428913 DOI: 10.2196/16471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Existing evaluations of the effects of mobile apps to encourage physical activity have been criticized owing to their common lack of external validity, their short duration, and their inability to explain the drivers of the observed effects. This protocol describes the setup of Health Telescope, a longitudinal panel study in which the long-term effects of mobile electronic health (eHealth) apps are investigated. By setting up Health Telescope, we aim to (1) understand more about the long-term use of eHealth apps in an externally valid setting, (2) understand the relationships between short-term and long-term outcomes of the usage of eHealth apps, and (3) test different ways in which eHealth app allocation can be personalized. OBJECTIVE The objectives of this paper are to (1) demonstrate and motivate the validity of the many choices that we made in setting up an intensive longitudinal study, (2) provide a resource for researchers interested in using data generated by our study, and (3) act as a guideline for researchers interested in setting up their own longitudinal data collection using wearable devices. For the third objective, we explicitly discuss the General Data Protection Regulation and ethical requirements that need to be addressed. METHODS In this 4-month study, a group of approximately 450 participants will have their daily step count measured and will be asked daily about their mood using experience sampling. Once per month, participants will receive an intervention containing a recommendation to download an app that focuses on increasing physical activity. The mechanism for assigning recommendations to participants will be personalized over time, using contextual data obtained from previous interventions. RESULTS The data collection software has been developed, and all the legal and ethical checks are in place. Recruitment will start in Q4 of 2020. The initial results will be published in 2021. CONCLUSIONS The aim of Health Telescope is to investigate how different individuals respond to different ways of being encouraged to increase their physical activity. In this paper, we detail the setup, methods, and analysis plan that will enable us to reach this aim. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/16471.
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Affiliation(s)
| | - Maurits Clemens Kaptein
- Jheronimus Academy of Data Science, 's-Hertogenbosch, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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Browne S, Kechadi MT, O'Donnell S, Dow M, Tully L, Doyle G, O'Malley G. Mobile Health Apps in Pediatric Obesity Treatment: Process Outcomes From a Feasibility Study of a Multicomponent Intervention. JMIR Mhealth Uhealth 2020; 8:e16925. [PMID: 32673267 PMCID: PMC7381070 DOI: 10.2196/16925] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Multicomponent family interventions underline current best practice in childhood obesity treatment. Mobile health (mHealth) adjuncts that address eating and physical activity behaviors have shown promise in clinical studies. OBJECTIVE This study aimed to describe process methods for applying an mHealth intervention to reduce the rate of eating and monitor physical activity among children with obesity. METHODS The study protocol was designed to incorporate 2 mHealth apps as an adjunct to usual care treatment for obesity. Children and adolescents (aged 9-16 years) with obesity (BMI ≥98th centile) were recruited in person from a weight management service at a tertiary health care center in the Republic of Ireland. Eligible participants and their parents received information leaflets, and informed consent and assent were signed. Participants completed 2 weeks of baseline testing, including behavioral and quality of life questionnaires, anthropometry, rate of eating by Mandolean, and physical activity level using a smart watch and the myBigO smartphone app. Thereafter, participants were randomized to the (1) intervention (usual clinical care+Mandolean training to reduce the rate of eating) or (2) control (usual clinical care) groups. Gender and age group (9.0-12.9 years and 13.0-16.9 years) stratifications were applied. At the end of a 4-week treatment period, participants repeated the 2-week testing period. Process evaluation measures included recruitment, study retention, fidelity parameters, acceptability, and user satisfaction. RESULTS A total of 20 participants were enrolled in the study. A web-based randomization system assigned 8 participants to the intervention group and 12 participants to the control group. Attrition rates were higher among the participants in the intervention group (5/8, 63%) than those in the control group (3/12, 25%). Intervention participants undertook a median of 1.0 training meal using Mandolean (25th centile 0, 75th centile 9.3), which represented 19.2% of planned intervention exposure. Only 50% (9/18) of participants with smart watches logged physical activity data. Significant differences in psychosocial profile were observed at baseline between the groups. The Child Behavior Checklist (CBCL) mean total score was 71.7 (SD 3.1) in the intervention group vs 57.6 (SD 6.6) in the control group, t-test P<.001, and also different among those who completed the planned protocol compared with those who withdrew early (CBCL mean total score 59.0, SD 9.3, vs 67.9, SD 5.6, respectively; t-test P=.04). CONCLUSIONS A high early attrition rate was a key barrier to full study implementation. Perceived task burden in combination with behavioral issues may have contributed to attrition. Low exposure to the experimental intervention was explained by poor acceptability of Mandolean as a home-based tool for treatment. Self-monitoring using myBigO and the smartwatch was acceptable among this cohort. Further technical and usability studies are needed to improve adherence in our patient group in the tertiary setting.
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Affiliation(s)
- Sarah Browne
- School Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M-Tahar Kechadi
- Insight Centre for Data Analytics, School of Computer Science, University College Dublin, Dublin, Ireland
| | - Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Mckenzie Dow
- School Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Louise Tully
- Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerardine Doyle
- UCD Michael Smurfit Graduate Business School, University College Dublin, Dublin, Ireland
| | - Grace O'Malley
- Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.,W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
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Adair KC, Rodriguez-Homs LG, Masoud S, Mosca PJ, Sexton JB. Gratitude at Work: Prospective Cohort Study of a Web-Based, Single-Exposure Well-Being Intervention for Health Care Workers. J Med Internet Res 2020; 22:e15562. [PMID: 32406864 PMCID: PMC7256751 DOI: 10.2196/15562] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Emotional exhaustion (EE) in health care workers is common and consequentially linked to lower quality of care. Effective interventions to address EE are urgently needed. OBJECTIVE This randomized single-exposure trial examined the efficacy of a gratitude letter-writing intervention for improving health care workers' well-being. METHODS A total of 1575 health care workers were randomly assigned to one of two gratitude letter-writing prompts (self- vs other focused) to assess differential efficacy. Assessments of EE, subjective happiness, work-life balance, and tool engagement were collected at baseline and 1-week post intervention. Participants received their EE score at baseline and quartile benchmarking scores. Paired-samples t tests, independent t tests, and correlations explored the efficacy of the intervention. Linguistic Inquiry and Word Count software assessed the linguistic content of the gratitude letters and associations with well-being. RESULTS Participants in both conditions showed significant improvements in EE, happiness, and work-life balance between the intervention and 1-week follow-up (P<.001). The self-focused (vs other) instruction conditions did not differentially predict improvement in any of the measures (P=.91). Tool engagement was high, and participants reporting higher motivation to improve their EE had higher EE at baseline (P<.001) and were more likely to improve EE a week later (P=.03). Linguistic analyses revealed that participants high on EE at baseline used more negative emotion words in their letters (P=.005). Reduction in EE at the 1-week follow-up was predicted at the level of a trend by using fewer first-person (P=.06) and positive emotion words (P=.09). No baseline differences were found between those who completed the follow-up assessment and those who did not (Ps>.05). CONCLUSIONS This single-exposure gratitude letter-writing intervention appears to be a promising low-cost, brief, and meaningful tool to improve the well-being of health care workers.
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Affiliation(s)
- Kathryn C Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | | | - Sabran Masoud
- Duke University School of Medicine, Durham, NC, United States
| | - Paul J Mosca
- Duke Network Services Duke University Health System, Duke University Health System, Durham, NC, United States
- Department of Surgery, Duke University School of Medicine, Duke University Health System, Durham, NC, United States
| | - J Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States
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Herrera L, Markle SL, Fukuda M, Aroca P, Villar A, Wang Y, Dominique G, Umoren O, Alegría M. Predictors of Research Assessment Completion in a Latino Sample with Dual Disorders. J Immigr Minor Health 2020; 22:1094-1100. [PMID: 32347414 DOI: 10.1007/s10903-020-01010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Latinos are underrepresented in clinical trials, where they encounter challenges in participation and a lack of effective recruitment and retention strategies. For Latino migrants with mental health and substance use problems, these challenges are even greater. Analyzing results from a multicenter randomized clinical trial for Latino migrants with mental health and substance use problems in Boston, Massachusetts, USA as well as Madrid and Barcelona, Spain, we describe six retention strategies used to facilitate participant engagement in follow-up assessments, and report the sociodemographic, clinical, and educational factors associated with research assessment completion. Among 341 randomized participants, 77% completed the 12-month follow-up and 75% completed at least 3 of the 4 follow-up assessments. Having a high school diploma, being recruited at community centers versus other sites, and having a less severe mental health condition were significantly associated with completing more follow-up interviews. Rigorous and customized methods reflecting participant's individual context can bolster research assessment completion for diverse Latino populations with behavioral health concerns.
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Affiliation(s)
- Lizbeth Herrera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Paloma Aroca
- Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Villar
- Department of Psychiatry, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Georgina Dominique
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Olivia Umoren
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA. .,Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA, USA.
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Engagement with a Web-Based Health Promotion Intervention among Vocational School Students: A Secondary User and Usage Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072180. [PMID: 32218251 PMCID: PMC7177298 DOI: 10.3390/ijerph17072180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/27/2022]
Abstract
Engagement with web-based interventions is both generally low and typically declining. Visits and revisits remain a challenge. Based on log data of a web-based cluster randomized controlled trial conducted in vocational schools, the present secondary analysis aimed to identify influencing factors on initially logging in to a health promotion platform among young adults and to examine the engagement over the course of an eight-week intervention. Data of 336 students (62.2% female, age span 18–25) from two intervention arms (web-based intervention and web-based intervention with an additional initial face-to-face contact) was included. Binary logistic regression and log-data visualization were performed. An additional initial face-to-face contact (odds ratio (OR) = 2.971, p = 0.005), female sex (OR = 2.237, p = 0.046) and the health-related skill “dealing with health information” (OR = 2.179, p = 0.030) significantly increased the likelihood of initially logging in. Other variables showed no influence. 16.6% of all potential users logged in at least once, of which 57.4% revisited the platform. Most logins were tracked at the beginning of the intervention and repeated engagement was low. To increase the engagement with web-based interventions, health-related skills should be fostered. In addition, a strategy could be to interlink comparable interventions in vocational schools more regularly with everyday teaching through multi-component interventions.
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Sears SF, Ford J. Seeking innovation in the delivery of psychosocial care for ICD patients. Eur Heart J 2020; 41:1212-1214. [PMID: 30957866 DOI: 10.1093/eurheartj/ehz167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Samuel F Sears
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Jessica Ford
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
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Ball E, Newton S, Rohricht F, Steed L, Birch J, Dodds J, Cantalapiedra Calvete C, Taylor S, Rivas C. mHealth: providing a mindfulness app for women with chronic pelvic pain in gynaecology outpatient clinics: qualitative data analysis of user experience and lessons learnt. BMJ Open 2020; 10:e030711. [PMID: 32165550 PMCID: PMC7069307 DOI: 10.1136/bmjopen-2019-030711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial. DESIGN A prestudy patient and public involvement (PPI) group to collect feedback on the acceptability of the existing app and study design was followed by a three-arm randomised feasibility trial. In addition, we undertook interviews and focus groups with patients and staff to explore app usability and acceptability. We also obtained participant comments on the research process, such as acceptability of the study questionnaires. SETTING Two gynaecology clinics within Barts Health NHS, London, UK. PARTICIPANTS Patients with CPP lasting ≥6 months with access to smartphone or personal computer and understanding of basic English. INTERVENTION The intervention was mindfulness meditation content plus additional pain module delivered by a smartphone app. Active controls received muscle relaxation content from the same app. Passive (waiting list) controls received usual care. MAIN OUTCOME MEASURES Themes on user feedback, app usability and integration, and reasons for using/not using the app. RESULTS The use of the app was low in both active groups. Patients in the prestudy PPI group, all volunteers, were enthusiastic about the app (convenience, content, portability, flexibility, ease of use). Women contributing to the interview or focus group data (n=14), from a 'real world' clinic (some not regular app users), were less positive, citing as barriers lack of opportunities/motivation to use the app and lack of familiarity and capabilities with technology. Staff (n=7) were concerned about the potential need for extra support for them and for the patients, and considered the app needed organisational backing and peer acceptance. CONCLUSION The opinions of prestudy PPI volunteers meeting in their private time may not represent those of patients recruited at a routine clinic appointment. It may be more successful to codesign/codevelop an app with typical users than to adapt existing apps for use in real-world clinical populations. TRIAL REGISTRATION NUMBER ISRCTN10925965.
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Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Sian Newton
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Frank Rohricht
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Liz Steed
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | - Julie Dodds
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | - Stephanie Taylor
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Carol Rivas
- UCL Social Research Institute, University College London, London, UK
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Arsenijevic J, Tummers L, Bosma N. Adherence to Electronic Health Tools Among Vulnerable Groups: Systematic Literature Review and Meta-Analysis. J Med Internet Res 2020; 22:e11613. [PMID: 32027311 PMCID: PMC7055852 DOI: 10.2196/11613] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/26/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023] Open
Abstract
Background Electronic health (eHealth) tools are increasingly being applied in health care. They are expected to improve access to health care, quality of health care, and health outcomes. Although the advantages of using these tools in health care are well described, it is unknown to what extent eHealth tools are effective when used by vulnerable population groups, such as the elderly, people with low socioeconomic status, single parents, minorities, or immigrants. Objective This study aimed to examine whether the design and implementation characteristics of eHealth tools contribute to better use of these tools among vulnerable groups. Methods In this systematic review, we assessed the design and implementation characteristics of eHealth tools that are used by vulnerable groups. In the meta-analysis, we used the adherence rate as an effect size measure. The adherence rate is defined as the number of people who are repetitive users (ie, use the eHealth tool more than once). We also performed a meta-regression analysis to examine how different design and implementation characteristics influenced the adherence rate. Results Currently, eHealth tools are continuously used by vulnerable groups but to a small extent. eHealth tools that use multimodal content (such as videos) and have the possibility for direct communication with providers show improved adherence among vulnerable groups. Conclusions eHealth tools that use multimodal content and provide the possibility for direct communication with providers have a higher adherence among vulnerable groups. However, most of the eHealth tools are not embedded within the health care system. They are usually focused on specific problems, such as diabetes or obesity. Hence, they do not provide comprehensive services for patients. This limits the use of eHealth tools as a replacement for existing health care services.
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Affiliation(s)
- Jelena Arsenijevic
- Utrecht University School of Governance, Faculty of Law Economics and Governance, Utrecht, Netherlands
| | - Lars Tummers
- Utrecht University School of Governance, Faculty of Law Economics and Governance, Utrecht, Netherlands
| | - Niels Bosma
- Utrecht University School of Economics, Faculty of Law Economics and Governance, Utrecht, Netherlands
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Raymond B, Luckett T, Johnson M, Hutchinson A, Lovell M, Phillips J. Low-intensity educational interventions supporting self-management to improve outcomes related to chronic breathlessness: a systematic review. NPJ Prim Care Respir Med 2019; 29:41. [PMID: 31784524 PMCID: PMC6884574 DOI: 10.1038/s41533-019-0152-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
Chronic breathlessness is debilitating and frightening, often resulting in emergency department presentations with acute-on-chronic breathlessness. Self-management is complex, involving 14 components as identified by the Practical Systematic Review in Self-Management Support (PRISMS). Low-intensity educational interventions that support breathlessness self-management through written/visual educational materials, alongside limited health professional support, are available. Our aim was to describe components of low-intensity educational interventions that support and improve self-management for adults with chronic breathlessness and evaluate their efficacy for improving breathlessness-related outcomes. A systematic review was conducted, including RCTs that compared these interventions with usual care in adults with chronic disease. Synthesis took a narrative approach utilizing the PRISMS taxonomy and Template for Intervention Description and Replication (TIDieR) checklist. Of the 1948 articles identified, 7 met criteria reporting 7 RCTs using 6 interventions. Studies utilized 12 out of 14 PRISMS components, the most frequent being training/rehearsal for psychological strategies. Evidence for effectiveness was inconsistent and attempts to identify beneficial components were confounded by intervention complexity and heterogeneity. The optimal content and delivery of low-intensity educational interventions that support self-management to improve chronic breathlessness-related outcomes in adults cannot be defined from current published literature. Future research should incorporate more detailed, standardized reporting to enable comparison and meta-analysis.
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Affiliation(s)
- Bronwyn Raymond
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Miriam Johnson
- Hull York Medical School, University of York, John Hughlings Jackson Building, Heslington, York, Y010 5DD, UK
| | - Ann Hutchinson
- Hull York Medical School, University of York, John Hughlings Jackson Building, Heslington, York, Y010 5DD, UK
| | - Melanie Lovell
- HammondCare, 95-115 River Road, Greenwich, NSW, 2065, Australia.,Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, NSW, 2050, Australia
| | - Jane Phillips
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia
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Boekhout JM, Peels DA, Berendsen BAJ, Bolman C, Lechner L. A Web-Based and Print-Delivered Computer-Tailored Physical Activity Intervention for Older Adults: Pretest-Posttest Intervention Study Comparing Delivery Mode Preference and Attrition. J Med Internet Res 2019; 21:e13416. [PMID: 31464186 PMCID: PMC6737888 DOI: 10.2196/13416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based interventions can play an important role in promoting physical activity (PA) behavior among older adults. Although the effectiveness of these interventions is promising, they are often characterized by low reach and high attrition, which considerably hampers their potential impact on public health. OBJECTIVE The aim of this study was to identify the participant characteristics associated with the preference for a Web-based or a printed delivery mode and to determine whether an association exists between delivery modes or participant characteristics and attrition in an intervention. This knowledge may enhance implementation, sustainability of participation, and effectiveness of future interventions for older adults. METHODS A real-life pretest-posttest intervention study was performed (N=409) among community-living single adults who were older than 65 years, with physical impairments caused by chronic diseases. Measurements were taken at baseline and 3 months after the start of the intervention. Hierarchical logistic regression was used to assess demographic and behavioral characteristics (age, gender, body mass index, educational attainment, degree of loneliness, and PA level), as well as psychosocial characteristics (social support for PA, modeling, self-efficacy, attitude, and intention) related to delivery mode preference at baseline and attrition after 3 months. RESULTS The printed delivery mode achieved higher participation (58.9%, 241/409) than the Web-based delivery mode (41.1%, 168/409). Participation in the Web-based delivery mode was associated with younger age (B=-0.10; SE 0.02; Exp (B)=0.91; P<.001) and higher levels of social support for PA (B=0.38; SE 0.14; Exp (B)=1.46; P=.01); attrition was associated with participation in the Web-based delivery mode (B=1.28; SE 0.28; Exp (B)=3.58; P<.001) and low educational attainment (B=-0.53; SE 0.28; Exp (B)=0.59; P=.049). CONCLUSIONS A total of 41% of the participants chose the Web-based delivery mode, thus demonstrating a potential interest of single older adults with physical impairments in Web-based delivered interventions. However, attrition was demonstrated to be higher in the Web-based delivery mode, and lower educational attainment was found to be a predictor for attrition. Characteristics predicting a preference for the printed delivery mode included being older and receiving less social support. Although Web-based delivery modes are generally less expensive and easier to distribute, it may be advisable to offer a printed delivery mode alongside a Web-based delivery mode to prevent exclusion of a large part of the target population. TRIAL REGISTRATION Netherlands Trial Register NTR2297; https://www.trialregister.nl/trial/2173. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-DOI: 10.2196/resprot.8093.
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Affiliation(s)
- Janet Maria Boekhout
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Denise Astrid Peels
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | | | - Catherine Bolman
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Lilian Lechner
- Department of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
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De Cocker K, Cardon G, Vergeer I, Radtke T, Vandelanotte C. Who Uses Action Planning in a Web-Based Computer-Tailored Intervention to Reduce Workplace Sitting and What do Action Plans Look Like? Analyses of the Start to stand Intervention among Flemish Employees. Appl Psychol Health Well Being 2019; 11:543-561. [PMID: 31215173 DOI: 10.1111/aphw.12167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Action planning plays an important role in many web-based behaviour change interventions. As such, it is important to identify who engages in action planning and what action plans look like. This study examines (1) attributes of users creating an action plan and (2) the content of action plans made during a web-based intervention to reduce workplace sitting. METHODS Users answered "what" (short standing breaks and/or longer periods of standing), "when" (working hours, work breaks, commuting), "where" (workplace, transport mode), and "how" (frequency, duration, implementation intentions) questions. MANOVA and chi-squared tests were conducted to compare those creating an action plan with those who did not. Descriptive statistics were used to examine the content of the action plans. RESULTS Those creating an action plan (n = 236/1,701) were significantly older, more sedentary at work, and more aware of health risks related to excessive sitting compared to those not planning (n = 1,465). The majority planned standing breaks (n = 212) every 30 minutes, and periods of standing (n = 173) for 1 to 2 hours. CONCLUSIONS Future interventions should promote action planning more, especially among younger employees and those with less health-related knowledge about sitting. Action plans were compatible with current sitting messages used in health promotion.
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Affiliation(s)
| | | | - Ineke Vergeer
- University of Southern Queensland, Springfield Central, Australia
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Young C, Campolonghi S, Ponsonby S, Dawson SL, O'Neil A, Kay-Lambkin F, McNaughton SA, Berk M, Jacka FN. Supporting Engagement, Adherence, and Behavior Change in Online Dietary Interventions. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:719-739. [PMID: 31036500 DOI: 10.1016/j.jneb.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Poor diet is a leading cause of death and disease globally. This epidemic requires effective and accessible interventions to stop the increasing number of diet-related deaths and the health and economic impacts of diet-related disease. Online interventions provide flexibility and accessibility. With the ubiquitous use of smartphones, they can be intertwined with daily activities such as shopping and eating. The aim of this review is to determine what features and behavior change techniques employed in online dietary interventions for adult populations promoting dietary behavior change. METHODS The researchers conducted a systematic search of Cumulative Index of Nursing and Allied Health, Cochrane Library, Global Health, MEDLINE, PsychINFO, and psychological and behavioral sciences electronic bibliography databases, and specialist electronic health (e-health) journals from database inception to January, 2018. Studies were included if they were randomized controlled trials of online dietary interventions with active comparator conditions in adult populations, and with reported dietary change measures. A quality score was applied to each study calculated by a developed scoring system. The review analyzed intervention dietary change measures, attrition (nonuse and dropout), engagement (metrics and intensity of use), adherence (defined as compliance to the treatment protocol), behavior change techniques employed to achieve dietary change, and techniques employed in successful (those who achieved significant results in the targeted dietary behavior) vs unsuccessful interventions as reported by the studies. RESULTS A total of 21 studies composed of a total of 7,455 adults and reporting on 19 different e-health interventions were included from 1,237 records. These studies targeted dietary change as measured by reduced energy intake (5) or changes in specific dietary components (15) and overall diet quality (4). Dietary change was a behavior target in general healthy populations (12) and for managing diseases such as obesity and cardiovascular disease (7), or for improving quality of life for those with chronic conditions (1). Improvements in dietary behavior were seen in 14 of the 19 interventions reported. DISCUSSION The results suggest that online interventions can be successful in achieving dietary behavior change across a range of defined populations. However, disparate reporting of engagement and limited reporting of nonuse attrition rates limited the analysis of which behavior change techniques were most effective in achieving this change. IMPLICATIONS FOR RESEARCH AND PRACTICE The results of this review support the potential of online and smartphone dietary interventions as a method to achieve change in diet in defined populations. However, further work needs to be done in examining how users engage with interventions, and thus which behavior change techniques are most effective.
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Affiliation(s)
- Claire Young
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia.
| | - Sara Campolonghi
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Stephanie Ponsonby
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Samantha L Dawson
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia; Early Life Epigenetics Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrienne O'Neil
- Centre for Mental Health, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Michael Berk
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Felice N Jacka
- Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Victoria, Australia; Black Dog Institute, New South Wales, Australia
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Bedendo A, Ferri CP, de Souza AAL, Andrade ALM, Noto AR. Pragmatic randomized controlled trial of a web-based intervention for alcohol use among Brazilian college students: Motivation as a moderating effect. Drug Alcohol Depend 2019; 199:92-100. [PMID: 31029880 DOI: 10.1016/j.drugalcdep.2019.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Web-based personalized normative feedback (PNF) interventions are less effective than their laboratory versions. Participant motivation may account for this reduced effect, but there is only a limited amount of research into the influence of motivation on PNF effectiveness. We evaluated the effectiveness of a web-based PNF in reducing alcohol use and consequences among college students with different motivation levels. METHODS Pragmatic randomized controlled trial among Brazilian college drinkers aged 18-30 years (N = 4460). Participants were randomized to a Control or PNF group and followed-up after one (T1), three (T2) and six (T3) months. Outcomes were: AUDIT score (primary outcome), the number of consequences, and the typical number of drinks. Motivation for receiving the intervention was assessed with a visual analog scale (range: 0-10). Generalized mixed models assessed intervention effects via two paradigms: observed cases and attrition models. RESULTS PNF reduced the number of typical drinks at T1 (OR = 0.71, p = 0.002), T2 (OR = 0.60, p < 0.001) and T3 (OR = 0.68, p = 0.016), compared to the control. Motivated students (score ≥3) receiving PNF also reduced the number of typical drinks at T1 (OR = 0.60, p < 0.001), T2 (OR = 0.55, p < 0.001) and T3 (OR = 0.56, p = 0.001), compared to the control. However, the attrition models were more robust at T1 and T2. In contrast, low-motivated students receiving the PNF increased AUDIT score at T3 (b = 1.49, p < 0.001). CONCLUSIONS The intervention reduced alcohol use, and motivation for receiving the intervention moderated the intervention effects. Motivated students reduced their typical alcohol use, whereas low-motivated students increased their AUDIT score.
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Affiliation(s)
- André Bedendo
- Department of Psychobiology, Research Center on Health and Substance Use (NEPSIS), Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1º Andar, Vila Clementino, Sao Paulo, CEP: 04023062, SP, Brazil; Department of Health Sciences, Faculty of Sciences, University of York, Seebohm Rowntree Bldg., Heslington, York, YO10 5DD United Kingdom.
| | - Cleusa Pinheiro Ferri
- Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1º Andar, Vila Clementino, Sao Paulo, SP, Brazil
| | - Altay Alves Lino de Souza
- Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1º Andar, Vila Clementino, Sao Paulo, SP, Brazil
| | - André Luiz Monezi Andrade
- Centro de Ciências da Vida (CCV), Pontifícia Universidade Católica de Campinas (PUC-Campinas), Av. John Boyd Dunlop, Jardim Ipaussurama, Campinas, SP, Brazil
| | - Ana Regina Noto
- Department of Psychobiology, Research Center on Health and Substance Use (NEPSIS), Universidade Federal de São Paulo - UNIFESP, Rua Botucatu, 862 - 1º Andar, Vila Clementino, Sao Paulo, CEP: 04023062, SP, Brazil
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