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Sasaki N, Ogawa S, Sawada U, Shimazu T, Powell BJ, Takeno H, Tsutsumi A, Imamura K. Effectiveness of an online text-based stress management program for employees who work in micro- and small-sized enterprises: A randomized controlled trial. Internet Interv 2024; 37:100754. [PMID: 39021784 PMCID: PMC11254178 DOI: 10.1016/j.invent.2024.100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Background Internet psychoeducational interventions improve employees' mental health. However, implementing them for employees in micro- and small-sized enterprises (MSEs) is challenging. Objectives This randomized controlled trial examined the effectiveness of a fully automated text-based stress management program, "WellBe-LINE," in improving mental health and job-related outcomes for employees in workplaces with fewer than 50 employees. Methods The program was developed based on stakeholder interviews and surveys of 1000 employees at MSEs. Adult full-time employees at an enterprise with fewer than 50 employees were recruited from registered members of a web survey company in Japan. Participants were randomly allocated to the intervention or control group (1:1). Participants in the intervention group were invited to register for the program using the LINE app. Psychological distress measured by Kessler 6 (K6) was a primary outcome, with self-administrated questionnaires at baseline, 2-month (post), and 6-month follow-ups. A mixed model for repeated measures conditional growth model analysis was conducted using a group ∗ time interaction as an intervention effect. Implementation outcomes were measured through implementation outcome scales for digital mental health (iOSDMH). Results 1021 employees were included in this study. No significant effects were shown in any outcome. The reported implementation outcomes were positively evaluated, with 80 % acceptability, 86 % appropriateness, and feasibility (ease of understanding the contents [88 %], frequency [86 %], and length of content [86 %]). Conclusions A simple text-message program for employees at MESs was acceptable, appropriate, and feasible; however, it did not result in improved mental health or job-related outcomes. Trial registration UMIN clinical trial registration: UMIN000050624 (registration date: March 18, 2023).
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Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Sayaka Ogawa
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Utako Sawada
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Hajime Takeno
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kotaro Imamura
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo
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Hallford DJ, Austin DW, Takano K, Yeow JJ, Rusanov D, Fuller-Tyszkiewicz M, Raes F. Improving usual care outcomes in major depression in youth by targeting memory specificity: A randomized controlled trial of adjunct computerized memory specificity training (c-MeST). J Affect Disord 2024; 358:500-512. [PMID: 38663556 DOI: 10.1016/j.jad.2024.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/11/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment. METHODS Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. RESULTS The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05). CONCLUSIONS c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.
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Affiliation(s)
- David John Hallford
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia.
| | - David W Austin
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Keisuke Takano
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstr. 13, Munich, Germany
| | - Joesph J Yeow
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Danielle Rusanov
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, 1 Gheringhap Street, Deakin University, Geelong, Victoria 3220, Melbourne, Australia
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3712, 3000 Leuven, Belgium
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Wilkes-Gillan S, Parsons L, Parsons D, Mahoney N, Hancock N, Cordier R, Lincoln M, Chen YWR, Bundy A. An evaluation of intervention appropriateness from the perspective of parents: A peer-mediated, play-based intervention for children with ADHD. Aust Occup Ther J 2024. [PMID: 39032070 DOI: 10.1111/1440-1630.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION A peer-mediated, play-based intervention has been developed to address social participation challenges experienced by children with ADHD. To facilitate implementation into clinical practice, interventions should be evaluated for appropriateness to the end-user, as well as effectiveness. Previous research demonstrated the approach is effective for improving children's social play skills. This study aimed to evaluate the appropriateness of the intervention for children with ADHD and their families. METHODS Parents of children with ADHD who participated in the play-based intervention were interviewed 1 month after completion. Parents were asked about their perspective of parent and children's experiences of the intervention, the perceived benefits for children and parents, the logistics of participating, and recommended adaptations to the intervention. Interviews were analysed thematically, and themes were mapped to the elements of the adopted definition of appropriateness to understand whether parents supported the appropriateness of the intervention for their families. CONSUMER AND COMMUNITY INVOLVEMENT Consumers were not directly involved in the decisions made about this study. FINDINGS One core theme, 'collaborative efforts', emerged from the data. Major themes comprising the core theme were 'on the same page', 'therapeutic relationship', and 'getting the job done'. Three sub-themes of 'engagement and motivation', 'the effort was worth it for the reward', and 'Rome wasn't built in a day' were nested within the major themes. CONCLUSION Parents largely supported the appropriateness of the intervention, indicating it addressed an important goal for their child, participation was a positive experience, and they perceived the intervention to be beneficial. Future adaptions of the intervention are needed to increase its ecological validity and to generalise the strategies to other social environments and playmates, such as peers at school. PLAIN LANGUAGE SUMMARY This study looked at an intervention that uses play with peers to help children with ADHD develop their play skills. The researchers wanted to know if parents thought the intervention was a good fit for their families and if it helped their children. Parents gave an interview a month after the intervention ended. They were asked about their thoughts on the intervention, how it helped their children and themselves, how easy it was to take part, and what changes could be made to make the intervention better. After analysing parents' answers, the researchers found parents mostly agreed that the intervention was a good fit. They said it helped their children to play with their peers, and they had a good time doing it. Parents thought the intervention was helpful, they liked that it was a joint effort between them and the occupational therapist, and they felt it was worth the effort. However, they also suggested some changes. They wanted the intervention to fit into other real-life social situations, such as school, so their children could use the skills they learned in other places. Overall, parents thought the intervention was helpful and suitable for their children and themselves, but some changes might make it more helpful.
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Affiliation(s)
- Sarah Wilkes-Gillan
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Dave Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Mahoney
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nicola Hancock
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, University of North Umbria, Newcastle upon Tyne, UK
| | - Michelle Lincoln
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Yu-Wei Ryan Chen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita Bundy
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
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Tagavi DM, Dai YG, Berger NI, Petruccelli M, Scott SE, Oosting D, Howard M, Carter AS, Ingersoll B, Wainer AL, Broder-Fingert S, Stone WL. Applying a User-Centered Design Framework to Develop a Remote Research Assessment Protocol for a Randomized Clinical Trial for Toddlers with Early Autism Characteristics. J Autism Dev Disord 2024:10.1007/s10803-024-06455-7. [PMID: 38985370 DOI: 10.1007/s10803-024-06455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
COVID-19 required many research teams to shift from in-person to remote assessments, which posed both procedural and theoretical challenges. While research has explored the utility of remote assessments for autism diagnosis from the perspective of families and clinicians, less is known about their application in clinical trials. This paper describes the development of a remote research assessment protocol for a randomized clinical trial focusing on the implementation of reciprocal imitation teaching (RIT) with toddlers in Part C early intervention. This project spans two phases. For Phase 1, our team developed and documented a series of steps utilizing user-centered design (UCD) strategies (e.g., recruiting potential users, creating a prototype, engaging in iterative development) for the purpose of redesigning an assessment protocol for a remote environment. For Phase 2, we examined preliminary outcomes of the redesign process. Primary end users (assessors) rated post-redesign usability and acceptability, while acceptability was examined using attrition data from secondary end users (family participants). Preliminary fidelity of implementation was also examined. The iterative redesign process allowed the research team to refine aspects of the assessment that ultimately led to promising preliminary ratings of usability, acceptability, and feasibility, as well as high fidelity. Preliminary data suggest that the redesigned assessment appears to be an acceptable, feasible, and usable tool for autism clinical trial research and that assessors can use it with fidelity. Further research is needed to examine the reliability and validity of the assessment, as well as implementation characteristics on a larger scale.
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Affiliation(s)
- Daina M Tagavi
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Yael G Dai
- Department of Psychology, Florida International University, Miami, USA
| | - Natalie I Berger
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | | | - Sabine E Scott
- Special Education and Clinical Sciences Department, University of Oregon, Eugene, USA
| | - Devon Oosting
- Department of Psychology, University of Massachusetts Boston, Boston, USA
| | - Mya Howard
- Department of Human Services, University of Virginia, Charlottesville, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, USA
| | - Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, USA
| | - Allison L Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | | | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, USA
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Li CYH, Platkin C, Chin J, Khan A, Bennett J, Speck A, Nielsen A, Leung MM. Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study. JMIR Form Res 2024; 8:e50557. [PMID: 38869926 PMCID: PMC11211703 DOI: 10.2196/50557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/12/2023] [Accepted: 12/05/2023] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. OBJECTIVE The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. METHODS College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. RESULTS A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). CONCLUSIONS Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses.
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Affiliation(s)
- Catherine Yan Hei Li
- Nutrition Program, School of Urban Public Health, Hunter College, The City University of New York, New York, NY, United States
| | - Charles Platkin
- Nutrition Program, School of Urban Public Health, Hunter College, The City University of New York, New York, NY, United States
- Hunter College New York City Food Policy Center, Hunter College, New York, NY, United States
- Center For Food As Medicine, New York, NY, United States
| | - Jonathan Chin
- Hunter College New York City Food Policy Center, Hunter College, New York, NY, United States
- Share Meals, Brooklyn, NY, United States
- Department of Physics and Computer Science, Medgar Evers College, The City University of New York, Brooklyn, NY, United States
| | - Asia Khan
- Public Health Program, School of Urban Public Health, Hunter College, The City University of New York, New York, NY, United States
| | - Jaleel Bennett
- Department of Physics and Computer Science, Medgar Evers College, The City University of New York, Brooklyn, NY, United States
| | - Anna Speck
- Nutrition Program, School of Urban Public Health, Hunter College, The City University of New York, New York, NY, United States
| | - Annette Nielsen
- Hunter College New York City Food Policy Center, Hunter College, New York, NY, United States
| | - May May Leung
- Nutrition Program, School of Urban Public Health, Hunter College, The City University of New York, New York, NY, United States
- Hunter College New York City Food Policy Center, Hunter College, New York, NY, United States
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Rothpletz-Puglia P, Smith J, Pavuk C, Leotta J, Pike K, Presley CJ, Krok-Schoen JL, Braun A, Cohen MK, Rogers GT, Chui KKH, Zhang FF, Spees CK. A theoretical explanation for how a nutrition counseling and medically tailored meal delivery program benefitted participants living with lung cancer. Support Care Cancer 2024; 32:428. [PMID: 38869623 PMCID: PMC11176247 DOI: 10.1007/s00520-024-08616-x] [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: 01/31/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The purpose of this study was to assess participants' perceptions and experiences while participating in a Food is Medicine medically tailored meal plus intensive nutrition counseling intervention to create a theoretical explanation about how the intervention worked. METHODS This interpretive qualitative study included the use of semi-structured interviews with active participants in a randomized controlled trial aimed at understanding how a medically tailored meal plus nutrition counseling intervention worked for vulnerable individuals with lung cancer treated at four cancer centers across the USA. During the 8-month long study, participants in the intervention arm were asked to be interviewed, which were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory. RESULTS Twenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention's mechanism of action. The explanatory process includes three linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life. CONCLUSIONS These findings provide evidence that a Food is Medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals' adjustment to their diagnosis and resulted in perceived positive behavior change.
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Affiliation(s)
- Pamela Rothpletz-Puglia
- Rutgers, The State University of New Jersey, School of Health Professions, New Brunswick, NJ, USA
| | - Jade Smith
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Chloe Pavuk
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Jana Leotta
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Kimberli Pike
- Rutgers, The State University of New Jersey, School of Health Professions, New Brunswick, NJ, USA
| | - Carolyn J Presley
- The James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Medical Oncology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- The James Comprehensive Cancer Center, Columbus, OH, USA
- School of Health and Rehabilitation Sciences, Division of Health Sciences, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Ashlea Braun
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Tulsa, OK, USA
| | - Mary Kathryn Cohen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gail T Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kenneth Kwan Ho Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Colleen K Spees
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA.
- The James Comprehensive Cancer Center, Columbus, OH, USA.
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Triplett NS, Mbwayo A, Kiche S, Sackey E, AlRasheed R, Okoth DA, Nyaboke OA, Amanya C, Dorsey S. "A problem shared is a problem solved:" integrating human-centered design and implementation science to optimize lay counselor supervision in Western Kenya. SSM - MENTAL HEALTH 2024; 5:100319. [PMID: 38938452 PMCID: PMC11210373 DOI: 10.1016/j.ssmmh.2024.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Implementation science and human-centered design (HCD) offer useful frameworks and methods for considering and designing for individuals' needs and preferences when implementing new interventions or technologies in global health. When used in tandem, the two approaches may blend creative and partnered research methods with a focus on the factors necessary to design, implement, and sustain interventions. However, research is needed that describes the process of blending these two approaches and explores the experiences of community partners. This study builds from a stepped-wedge cluster-randomized trial in Western Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy (TF-CBT). Mobile phones emerged as a tool to supervise lay counselors from afar; however, their use was characterized by unique challenges. Informed by human-centered design and implementation science, we first engaged lay counselors (n = 24) and supervisors (n = 3) in individual semi-structured interviews then hosted an in-person participatory workshop to "co-design" solutions to optimize the use of mobile phone supervision. Lay counselors participated in focus group discussions regarding their experiences in the workshop. Focus group transcripts were analyzed using thematic analysis. We describe our approach as well as focus group discussion results. Counselors felt the workshop was a valuable experience to learn new strategies from their colleagues, and they enjoyed the "collaborative spirit" that emerged as they worked together. Counselors felt that varying small and large group discussions fostered participation by creating opportunities for more people to engage and share their thoughts. Counselors suggested the approach be improved by providing more tangible materials (e.g., hand-outs) and more closely following a schedule of activities. It is important to also center stakeholders' experiences as partners in the research process. Though counselors largely expressed positive sentiments, they also shared valuable suggestions for how to improve participatory research practices in the future.
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Affiliation(s)
- Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Sharon Kiche
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Enoch Sackey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | | | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Dir AL, O'Reilly L, Pederson C, Schwartz K, Brown SA, Reda K, Gillenwater L, Gharbi S, Wiehe SE, Adams ZW, Hulvershorn LA, Zapolski TCB, Boustani M, Aalsma MC. Early development of local data dashboards to depict the substance use care cascade for youth involved in the legal system: qualitative findings from end users. BMC Health Serv Res 2024; 24:687. [PMID: 38816829 PMCID: PMC11140904 DOI: 10.1186/s12913-024-11126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Rates of substance use are high among youth involved in the legal system (YILS); however, YILS are less likely to initiate and complete substance use treatment compared to their non legally-involved peers. There are multiple steps involved in connecting youth to needed services, from screening and referral within the juvenile legal system to treatment initiation and completion within the behavioral health system. Understanding potential gaps in the care continuum requires data and decision-making from these two systems. The current study reports on the development of data dashboards that integrate these systems' data to help guide decisions to improve substance use screening and treatment for YILS, focusing on end-user feedback regarding dashboard utility. METHODS Three focus groups were conducted with n = 21 end-users from juvenile legal systems and community mental health centers in front-line positions and in decision-making roles across 8 counties to gather feedback on an early version of the data dashboards; dashboards were then modified based on feedback. RESULTS Qualitative analysis revealed topics related to (1) important aesthetic features of the dashboard, (2) user features such as filtering options and benchmarking to compare local data with other counties, and (3) the centrality of consistent terminology for data dashboard elements. Results also revealed the use of dashboards to facilitate collaboration between legal and behavioral health systems. CONCLUSIONS Feedback from end-users highlight important design elements and dashboard utility as well as the challenges of working with cross-system and cross-jurisdiction data.
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Affiliation(s)
- Allyson L Dir
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St. Suite 2000, Indianapolis, IN, 46222, USA.
| | - Lauren O'Reilly
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Casey Pederson
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St. Suite 2000, Indianapolis, IN, 46222, USA
| | - Katherine Schwartz
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven A Brown
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Khairi Reda
- Luddy School of Informatics, Computing, and Engineering, Indiana University-Indianapolis, Indianapolis, IN, USA
| | - Logan Gillenwater
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sami Gharbi
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah E Wiehe
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St. Suite 2000, Indianapolis, IN, 46222, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St. Suite 2000, Indianapolis, IN, 46222, USA
| | - Tamika C B Zapolski
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St. Suite 2000, Indianapolis, IN, 46222, USA
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Ray J, Finn EB, Tyrrell H, Aloe CF, Perrin EM, Wood CT, Miner DS, Grout R, Michel JJ, Damschroder LJ, Sharifi M. User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies. J Med Internet Res 2024; 26:e51952. [PMID: 38771622 PMCID: PMC11150893 DOI: 10.2196/51952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/30/2023] [Accepted: 02/17/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Electronic health record-based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. OBJECTIVE This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. METHODS In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. RESULTS We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. CONCLUSIONS UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011.
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Affiliation(s)
- Jessica Ray
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Emily Benjamin Finn
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | | | - Carlin F Aloe
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins University School of Medicine and School of Nursing, Baltimore, MD, United States
| | - Charles T Wood
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Dean S Miner
- Departments of Pediatrics and Internal Medicine, East Carolina University, Greenville, NC, United States
| | - Randall Grout
- Department of Pediatrics, Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, United States
| | - Jeremy J Michel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Laura J Damschroder
- Implementation Pathways, LLC and Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Mona Sharifi
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
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Mancinelli E, Gabrielli S, Salcuni S. A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study. JMIR Hum Factors 2024; 11:e50098. [PMID: 38753421 PMCID: PMC11140274 DOI: 10.2196/50098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/05/2023] [Accepted: 03/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. OBJECTIVE This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women's needs. Usability and user engagement were evaluated. METHODS A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. RESULTS Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention's goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. CONCLUSIONS Overall, the findings have emphasized both the intervention's merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention's content to pregnant women's needs.
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Affiliation(s)
- Elisa Mancinelli
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
- Fondazione Bruno Kessler, Trento, Italy
| | | | - Silvia Salcuni
- Department of Developmental and Socialization Psychology, University of Padova, Padova, Italy
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Huang TTK, Callahan EA, Haines ER, Hooley C, Sorensen DM, Lounsbury DW, Sabounchi NS, Hovmand PS. Leveraging systems science and design thinking to advance implementation science: moving toward a solution-oriented paradigm. Front Public Health 2024; 12:1368050. [PMID: 38813425 PMCID: PMC11135204 DOI: 10.3389/fpubh.2024.1368050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Many public health challenges are characterized by complexity that reflects the dynamic systems in which they occur. Such systems involve multiple interdependent factors, actors, and sectors that influence health, and are a primary driver of challenges of insufficient implementation, sustainment, and scale of evidence-based public health interventions. Implementation science frameworks have been developed to help embed evidence-based interventions in diverse settings and identify key factors that facilitate or hinder implementation. These frameworks are largely static in that they do not explain the nature and dynamics of interrelationships among the identified determinants, nor how those determinants might change over time. Furthermore, most implementation science frameworks are top-down, deterministic, and linear, leaving critical gaps in understanding of both how to intervene on determinants of successful implementation and how to scale evidence-based solutions. Design thinking and systems science offer methods for transforming this problem-oriented paradigm into one that is solution-oriented. This article describes these two approaches and how they can be integrated into implementation science strategies to promote implementation, sustainment, and scaling of public health innovation, ultimately resulting in transformative systems changes that improve population health.
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Affiliation(s)
- Terry T.-K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | | | - Emily R. Haines
- School of Medicine, Wake Forest University, Winston-Salem, NC, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | | | - David W. Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Nasim S. Sabounchi
- Center for Systems and Community Design, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, United States
| | - Peter S. Hovmand
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Tømmerås T, Backer-Grøndahl A, Høstmælingen A, Laland H, Gomez MB, Apeland A, Karlsson LRA, Grønlie AA, Torsvik S, Bringedal GE, Monica A, Fisher PA, Gardner F, Kjøbli J, Malmberg-Heimonen I, Nissen-Lie HA. Study protocol for a randomized controlled trial of supportive parents - coping kids (SPARCK)-a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems. BMC Psychol 2024; 12:264. [PMID: 38741201 DOI: 10.1186/s40359-024-01765-y] [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: 02/01/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND To meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents - coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent-child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group). METHODS We describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up. DISCUSSION The current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology. TRIAL REGISTRATION ClinicalTrials.gov ID: NTCT05800522.
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Affiliation(s)
- T Tømmerås
- Norwegian Center for Child Behavioral Development, Oslo, Norway.
| | | | - A Høstmælingen
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - H Laland
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - M B Gomez
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - A Apeland
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - L R A Karlsson
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - A A Grønlie
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - S Torsvik
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - G E Bringedal
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Aas Monica
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Social, Genetic and Developmental Psychiatry Centre, Psychology and Neuroscience, Kings College, London, UK
| | - Phillip Andrew Fisher
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Stanford University, Graduate School of Education, Stanford, US
| | - Frances Gardner
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - John Kjøbli
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Ira Malmberg-Heimonen
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- Oslo Metropolitan University, Faculty of Social Work, Oslo, Norway
| | - Helene Amundsen Nissen-Lie
- Norwegian Center for Child Behavioral Development, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
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Slovak P, Munson SA. HCI Contributions in Mental Health: A Modular Framework to Guide Psychosocial Intervention Design. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:692. [PMID: 38770195 PMCID: PMC11105670 DOI: 10.1145/3613904.3642624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Many people prefer psychosocial interventions for mental health care or other concerns, but these interventions are often complex and unavailable in settings where people seek care. Intervention designers use technology to improve user experience or reach of interventions, and HCI researchers have made many contributions toward this goal. Both HCI and mental health researchers must navigate tensions between innovating on and adhering to the theories of change that guide intervention design. In this paper, we propose a framework that describes design briefs and evaluation approaches for HCI contributions at the scopes of capabilities, components, intervention systems, and intervention implementations. We show how theories of change (from mental health) can be translated into design briefs (in HCI), and that these translations can bridge and coordinate efforts across fields. It is our hope that this framework can support researchers in motivating, planning, conducting, and communicating work that advances psychosocial intervention design.
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14
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Vaillant-Coindard E, Briet G, Lespiau F, Gisclard B, Charbonnier E. Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial. BMC Psychol 2024; 12:204. [PMID: 38615007 PMCID: PMC11016224 DOI: 10.1186/s40359-024-01723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.
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Affiliation(s)
| | - Gaëtan Briet
- UNIV. NIMES, APSY-V, F-30021, Nîmes Cedex 1, France
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15
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Ross DC, McCallum N, Truuvert AK, Butt A, Behdinan T, Rojas D, Soklaridis S, Vigod S. The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma. J Ment Health 2024:1-10. [PMID: 38572918 DOI: 10.1080/09638237.2024.2332797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/05/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population. AIMS To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program. METHODS Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted. RESULTS Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming. CONCLUSIONS Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.
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Affiliation(s)
- Dana C Ross
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McCallum
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie K Truuvert
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Aysha Butt
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Tina Behdinan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Rojas
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Lukka L, Karhulahti VM, Bergman VR, Palva JM. Measuring digital intervention user experience with a novel ecological momentary assessment (EMA) method, CORTO. Internet Interv 2024; 35:100706. [PMID: 38274123 PMCID: PMC10808917 DOI: 10.1016/j.invent.2023.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Digital interventions often suffer from low usage, which may reflect insufficient attention to user experience. Moreover, the existing evaluation methods have limited applicability in the remote study of user experience of complex interventions that have expansive content and that are used over an extensive period of time. To alleviate these challenges, we describe here a novel qualitative Ecological Momentary Assessment (EMA) method: the CORTO method (Contextual, One-item, Repeated, Timely, Open-ended). We used it to gather digital intervention user experience data from Finnish adults (n = 184) who lived with interview-confirmed major depressive disorder (MDD) and took part in a randomized controlled trial (RCT) that studied the efficacy of a novel 12-week game-based digital intervention for depression. A second dataset on user experience was gathered with retrospective interviews (n = 22). We inductively coded the CORTO method and retrospective interview data, which led to four user experience categories: (1) contextual use, (2) interaction-elicited emotional experience, (3) usability, and (4) technical issues. Then, we used the created user experience categories and Template Analysis to analyze both datasets together, and reported the results qualitatively. Finally, we compared the two datasets with each other. We found that the data generated with the CORTO method offered more insights into usability and technical categories than the interview data that particularly illustrated the contextual use. The emotional valence of the interview data was more positive compared with the CORTO data. Both the CORTO and interview data detected 55 % of the micro-level categories; 20 % of micro-level categories were only detected by the CORTO data and 25 % only by the interview data. We found that the during-intervention user experience measurement with the CORTO method can provide intervention-specific insights, and thereby further the iterative user-centered intervention development. Overall, these findings highlight the impact of evaluation methods on the categories and qualities of insights acquired in intervention research.
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Affiliation(s)
- Lauri Lukka
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | | | - Vilma-Reetta Bergman
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | - J. Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Finland
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom
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Drozd F, Pettersen Sandtrø H, Leksbø TS, Haga SM, Jacobsen H, Størksen HT. Identifying and developing strategies for implementation of a guided internet- and mobile-based infant sleep intervention in well-baby and community mental health clinics using group concept mapping. BMC Health Serv Res 2024; 24:175. [PMID: 38326797 PMCID: PMC10851561 DOI: 10.1186/s12913-024-10632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND This study aimed to identify strategies for the implementation of a guided internet- and mobile-based intervention (IMI) for infant sleep problems ("Sleep Well, Little Sweetheart") in well-baby and community mental health clinics. STUDY DESIGN We used group concept mapping, a two-phased mixed methods approach, conducted as a two-day workshop in each clinic. We recruited 20 participants from four clinics and collected sorting and rating data for implementation strategies based on the Expert Recommendations for Implementing Change taxonomy and brainstorming sessions. Data were analyzed using descriptive statistics, multidimensional scaling, and hierarchical cluster analysis to create cluster maps, laddergrams, and Go-Zone graphs. Participants were presented with the results and discussed and interpreted the findings at each of the clinics in spring 2022. RESULTS Participants identified 10 clusters of strategies, of which Training, Embedding and Coherence, User Involvement and Participation, and Clinician Support and Implementation Counseling were rated as most important and feasible. Economy and Funding and Interactive and Interdisciplinary Collaboration were rated significantly lower on importance and feasibility compared to many of the clusters (all ps < 0.05). There was a correlation between the importance and feasibility ratings (r =.62, p =.004). CONCLUSIONS The use of group concept mapping made it possible to efficiently examine well-baby and community clinics' perspectives on complex issues, and to acquire specific knowledge to allow for the planning and prioritization of strategies for implementation. These results suggest areas of priority for the implementation of IMIs related to infant sleep problems. TRIAL REGISTRATION The study was pre-registered at Open Science Framework ( www.osf.io/emct8 ).
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Affiliation(s)
- Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway.
| | - Hege Pettersen Sandtrø
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Turid Skjerve Leksbø
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Heidi Jacobsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
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Vamos CA, Puccio JA, Griner SB, Logan RG, Piepenbrink R, Richardson Cayama M, Lovett SM, Mahony H, Daley EM. Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:477-486. [PMID: 35298353 DOI: 10.1080/07448481.2022.2040517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.
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Affiliation(s)
- Cheryl A Vamos
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Joseph A Puccio
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Stacey B Griner
- University of North Texas Health Science Center at Fort Worth, School of Public Health, Fort Worth, TX, USA
| | | | | | | | - Sharonda M Lovett
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Helen Mahony
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Ellen M Daley
- University of South Florida, College of Public Health, Tampa, FL, USA
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Kamp K, Yang PL, Friedman E, Lopez A, Iribarren S, Barney P, Munson S, Heitkemper M, Levy R. Formative Evaluation of a Comprehensive Self-Management Intervention for Irritable Bowel Syndrome, Comorbid Anxiety, and Depression: Mixed Methods Study. JMIR Form Res 2024; 8:e43286. [PMID: 38294871 PMCID: PMC10867748 DOI: 10.2196/43286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a disorder of the gut-brain interaction that is associated with abdominal pain, altered bowel patterns, and reduced quality of life. Up to 50% of patients with IBS also report anxiety or depressive symptoms. Although effective self-management interventions exist for individuals with IBS, few have been effectively implemented, and most do not consider the unique needs of patients with comorbid IBS and anxiety or depression. OBJECTIVE This study aimed to determine the anticipated acceptability, appropriateness, feasibility, and usability of a comprehensive self-management intervention using an implementation science and human-centered design approach among individuals with comorbid IBS and anxiety or depression and health care providers. METHODS A convergent mixed methods design was used to elicit feedback on the comprehensive self-management intervention outline and content to identify refinement needs before testing. Patients with IBS and moderate to severe anxiety or depression and health care providers were purposefully sampled from primary care and gastroenterology settings. Participants completed semistructured interviews and surveys on anticipated acceptability, appropriateness, feasibility, and usability. RESULTS Patient participants (n=12) were on average 36.8 (SD 12.2) years of age, and 42% (5/12) were currently receiving psychological therapy. Health care providers (n=14) were from primary care (n=7) and gastroenterology (n=7) settings. The mean usability scores (out of 100) were 52.5 (SD 14.5) for patients and 45.6 (SD 11.6) for providers. For patients and providers, qualitative data expanded the quantitative findings for acceptability and appropriateness. Acceptability findings were the comprehensive nature of the intervention and discussion of the gut-brain interaction. For appropriateness, participants reported that the intervention provided structure, accountability, and support. Feasibility was confirmed for patients, but there was a divergence of findings between quantitative and qualitative measures for providers. Patients focused on intervention feasibility, while providers focused on implementation feasibility in the clinic. Identified usability issues to address before implementation included the intervention delivery format, length, and lack of integration into health care settings that, if not addressed, may limit the reach of the intervention. CONCLUSIONS Patients and health care providers found the intervention acceptable and appropriate. Several feasibility and usability issues were identified, including intervention delivery methods, length of intervention, and the best methods to implement in the clinic setting. The next steps are to refine the intervention to address the identified issues and test in a pilot study whether addressing usability issues leads to the anticipated improvements in implementation and uptake.
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Affiliation(s)
- Kendra Kamp
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | | | - Emily Friedman
- Alacrity Center, University of Washington, Seattle, WA, United States
| | - Alejandra Lopez
- Alacrity Center, University of Washington, Seattle, WA, United States
| | - Sarah Iribarren
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Pamela Barney
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Sean Munson
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Rona Levy
- School of Social Work, University of Washington, Seattle, WA, United States
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Wood JJ, Wood KS, Rosenau KA, Cho AC, Johnson AR, Muscatello VS, Tien IS, Straus J, Wolpe S, Zeldin A, Kazlauskas K, McLeod BD. Practitioner Adherence and Competence in MEYA, a Free Online Self-Instruction Program in Modular Psychotherapy and Counseling for Children's Autism-Related Clinical Needs. J Autism Dev Disord 2024:10.1007/s10803-023-06226-w. [PMID: 38277075 DOI: 10.1007/s10803-023-06226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
The quality of care in public schools and other community settings for school-aged youths on the autism spectrum is variable and often not evidence-based. Training practitioners in these settings to deliver evidence-based practices (EBPs) may improve the quality of care. We developed a free internet-based training and clinical guidance system synthesizing multiple EBPs for youth on the autism spectrum addressing a range of mental health needs and autism-related behaviors, entitled Modular EBPs for Youth on the Autism Spectrum (MEYA; meya.ucla.edu). A multiple baseline study was conducted with seven practitioners recruited from mental health practice settings across the United States who were providing services to children on the autism spectrum (aged 6 to 17 years). Practitioners were randomly assigned to undergo baseline conditions of 2 to 8 weeks. Once online training in MEYA commenced, practitioners engaged in algorithm-guided self-instruction in EBPs for autism. Participants video-recorded sessions. Independent coders used the MEYA Fidelity Scale (MEYA-FS) to rate adherence and competence in EBPs for autism. Practitioners also completed measures pertaining to implementation outcomes and parents rated youth outcomes on personalized target behaviors. Five of seven practitioners increased their adherence to MEYA practices (i.e., MEYA-FS scores) following MEYA training. Findings for competence were similar, though somewhat less robust. Practitioners generally viewed MEYA as feasible, understandable, and acceptable. Most youth outcomes improved during MEYA. A randomized, controlled trial of MEYA would be helpful in characterizing its effectiveness for supporting practitioner EBP implementation and youth outcomes in school and community service settings.
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Affiliation(s)
- Jeffrey J Wood
- Department of Education, University of California Los Angeles, Los Angeles, USA.
- Department of Psychiatry, University of California Los Angeles, Los Angeles, USA.
| | - Karen S Wood
- Department of Psychiatry, University of California Los Angeles, Los Angeles, USA
| | - Kashia A Rosenau
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - An Chuen Cho
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | - Amanda R Johnson
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | | | - Ingrid S Tien
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | - Jolie Straus
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | - Samara Wolpe
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | | | | | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
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Sourander A, Ishikawa S, Ståhlberg T, Kishida K, Mori Y, Matsubara K, Zhang X, Hida N, Korpilahti-Leino T, Ristkari T, Torii S, Gilbert S, Hinkka-Yli-Salomäki S, Savolainen H, Närhi V. Cultural adaptation, content, and protocol of a feasibility study of school-based "Let's learn about emotions" intervention for Finnish primary school children. Front Psychiatry 2024; 14:1334282. [PMID: 38274431 PMCID: PMC10810134 DOI: 10.3389/fpsyt.2023.1334282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Emotional awareness and emotion regulation are crucial for cognitive and socio-emotional development in children. School-based interventions on socio-emotional skills have the potential to prevent these problems and promote well-being of children. The Japanese school-based program, Universal Unified Prevention Program for Diverse Disorders (Up2-D2), has shown preventive effects on mental health of children in Japan. The aims of this protocol paper are to describe the unique process of adapting the Up2-D2 from Eastern to Western context, and to present a feasibility study of the intervention, conducted in Finland. Methods The cultural adaptation process started with the linguistic translation of materials, followed by the modification of language to fit the Finnish context. While the Japanese ideology was saved, some content was adapted to fit Finnish school children. Further modifications were made based on feedback from pupils and teachers. The Finnish version of the program was named "Let's learn about emotions" and consisted of 12 sessions and targeted 8- to 12-year-old pupils. A teacher education plan was established to assist Finnish teachers with the intervention, including a workshop, teachers' manual, brief introductory videos, and online support sessions. A feasibility study involving 512 4th graders in the City of Hyvinkää, South of Finland, was conducted. It assessed emotional and behavioral problems, classroom climate, bullying, loneliness, perception of school environment, knowledge of emotional awareness, and program acceptability. Discussion The originality of this study underlies in the East-West adaptation of a cognitive behavioral therapy-based program. If promising feasibility findings are replicated in Finland, it could pave the way for further research on implementing such programs in diverse contexts and cultures, promoting coping skills, awareness, social skills and early prevention of child mental health problems. Ethics The ethical board of the University of Turku gave ethics approval for this research. The educational board of the City of Hyvinkää accepted this study.
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Affiliation(s)
- A. Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
- Department for Child Psychiatry, Turku University Hospital, Turku, Finland
| | - S. Ishikawa
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - T. Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
- Department for Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - K. Kishida
- School of Humanities, Kwansei Gakuin University, Nishinomiya, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Y. Mori
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - K. Matsubara
- Organization for Research Initiatives and Development, Doshisha University, Kyoto, Japan
| | - X. Zhang
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - N. Hida
- Center for Wing of Empirically Supported Treatments, Doshisha University, Kyoto, Japan
| | - T. Korpilahti-Leino
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - T. Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - S. Torii
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - S. Gilbert
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - S. Hinkka-Yli-Salomäki
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Flagship Centre, University of Turku, Turku, Finland
| | - H. Savolainen
- School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
| | - V. Närhi
- Department of Education, University of Jyväskylä, Jyväskylä, Finland
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Kaittila A, Isoniemi H, Viitasalo K, Moisio M, Raijas A, Toikka E, Tuominen J, Hakovirta M. A Pilot Randomized Controlled Trial of Intervention for Social Work Clients with Children Facing Complex Financial Problems in Finland (FinSoc): A Study Protocol. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:32-49. [PMID: 37712670 DOI: 10.1080/26408066.2023.2257174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE Social work clients often face complex financial problems. We have developed a financial social work intervention, FinSoc, to increase financial literacy and economic self-efficacy and reduce financial anxiety among parents with financial problems in Finland. The aim of this pilot randomized controlled trial is to explore the feasibility, acceptability, and preliminary effectiveness of the intervention. This paper, a study protocol, describes the design and implementation of the trial. Study protocols are articles detailing a priori the research plan, rationale, proposed methods and plans for how a clinical trial will be conducted. METHOD This study is a pilot randomized controlled trial with a mixed methods approach applying both quantitative measures and qualitative interviews. Participating social work clients with children are randomly assigned to either the treatment or the waiting list control group at a ratio of 1:1. The treatment group receives the intervention and the control group receives services as usual. The quantitative data from social work clients are collected at three measurement points. Qualitative interviews are conducted post-intervention with both clients receiving, and professionals implementing the intervention. The feasibility is assessed through recruitment and retention rates and the interviews with social work professionals providing the intervention. Acceptability is assessed through feedback from participants on satisfaction with the intervention and usefulness of the specific intervention components. Potential effectiveness is measured by financial literacy, economic self-efficacy and financial anxiety. DISCUSSION The intervention is hypothesized to increase financial literacy and economic self-efficacy and reduce financial anxiety among social work clients with children. The results of this pilot study will increase the evidence base of financial social work and offer new insights for developing interventions for clients experiencing financial difficulties.
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Affiliation(s)
| | | | - Katri Viitasalo
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Meri Moisio
- INVEST Flagship, University of Turku, Turku, Finland
| | - Anu Raijas
- Bank of Finland Museum, Bank of Finland, Helsinki, Finland
| | - Enna Toikka
- Department of Social Research, University of Turku, Turku, Finland
| | - Jarno Tuominen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Mia Hakovirta
- INVEST Flagship, University of Turku, Turku, Finland
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Kathono J, Nyongesa V, Mwaniga S, Obonyo G, Yator O, Wambugu M, Banerjee J, Breuer E, Duffy M, Lai J, Levy M, Njuguna S, Kumar M. Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach. PLoS One 2024; 19:e0290868. [PMID: 38165879 PMCID: PMC10760697 DOI: 10.1371/journal.pone.0290868] [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: 08/05/2022] [Accepted: 08/17/2023] [Indexed: 01/04/2024] Open
Abstract
In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.
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Affiliation(s)
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Erica Breuer
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Malia Duffy
- St Ambrose University, Davenport, Iowa, United States of America
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, NY, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, NY, United States of America
| | - Simon Njuguna
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States of America
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24
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O'Hara KL, Cohen B. A call for early, effective, and scalable parent education programs for high-conflict separated/divorcing parents: A synthesized perspective from prevention science and family law. FAMILY COURT REVIEW 2024; 62:160-175. [PMID: 38495867 PMCID: PMC10938872 DOI: 10.1111/fcre.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/19/2023] [Indexed: 03/19/2024]
Abstract
Conflict between parents is stressful and disruptive to children living in the midst of parental separation or divorce. Although some level of post-separation/divorce conflict is understandable in an emotionally-charged separation/divorce, it undermines the extent to which parents protect their children from short- and long-term problems. In this article, we weave together a synthesized perspective informed by our respective training and experience in prevention science and family law on the role of parent education programs for high-conflict separating/divorcing parents. To do so, we first describe the research on the effects of high interparental conflict on children's outcomes and then discuss current approaches and challenges to reducing these negative effects by offering parent education programs for high-conflict separating/divorcing parents. Then, we propose and describe a new model for early, effective, and scalable parent education programs with the ultimate goal of protecting children after separation/divorce.
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Affiliation(s)
- K L O'Hara
- REACH Institute, Arizona State University
| | - B Cohen
- Maricopa County Superior Court
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Pacheco-Barrios K, Gianlorenco AC, Camargo L, Dodurgali MR, Tangjade A, Fregni F. Accelerating the development of noninvasive brain stimulation devices: using design thinking to facilitate its clinical use and acceptance. Expert Rev Neurother 2024; 24:5-9. [PMID: 38149610 PMCID: PMC10983014 DOI: 10.1080/14737175.2023.2292733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Anna Carolyna Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Lucas Camargo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mustafa Reha Dodurgali
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anamon Tangjade
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Rehabilitation Medicine, Vajira hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Galica J, Silva A, Robb K. Developing an educational resource for gynecological cancer survivors and their caregivers: A methods and experience paper. Can Oncol Nurs J 2024; 34:4-9. [PMID: 38352933 PMCID: PMC10861237 DOI: 10.5737/236880763414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Building upon the need for greater education, identified by gynecological cancer survivors and their caregivers, the objective of this paper is to describe our patient-clinician-researcher partnership to develop an evidence- and experiential-based educational resource. We engaged in five phases using multiple research methods: 1) assembling the essential expertise, 2) reviewing the literature, 3) drafting the resource, 4) testing the resource, and 5) disseminating the resource. Our diverse partnership provided expertise toward multiple research methods that produced results useful for each successive phase. This combination - a diverse partnership and multiple research methods - resulted in a useful resource to fulfill a gap identified by knowledge users. The combined features described in our paper fill a procedural gap for clinicians and researchers intending to develop educational resources that are empirically and experientially founded.
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Affiliation(s)
- Jacqueline Galica
- Queen's University School of Nursing; Kingston, ON; Queen's Cancer Research Institute, Division of Cancer Care and Epidemiology, Kingston, ON
| | - Amina Silva
- Brock University School of Nursing; St. Catharines, ON
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Galica J, Silva A, Robb K. Élaboration d’une ressource d’information à l’intention des survivantes d’un cancer gynécologique et de leurs proches aidants : exposé sur le vécu et les méthodes. Can Oncol Nurs J 2024; 34:10-15. [PMID: 38352925 PMCID: PMC10861229 DOI: 10.5737/2368807634110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Le présent article fait ressortir la nécessité de mieux informer les survivantes de cancer gynécologique (CG) et leurs proches aidants. Il vise à décrire le partenariat établi entre les patientes, les cliniciens et les chercheurs pour concevoir une ressource d’information fondée sur l’expérience et les données probantes. L’élaboration de cette ressource d’information a fait appel à plusieurs méthodes de recherche. Elle s’est déroulée en cinq étapes : 1) réunion de l’expertise nécessaire; 2) revue de la littérature; 3) ébauche de la ressource; 4) mise à l’essai; 5) diffusion de la ressource. La diversité des partenaires apportait l’expertise nécessaire à l’utilisation de multiples méthodes de recherche ayant produit des résultats utiles à chaque étape. Grâce à cette combinaison (partenariat diversifié et multiples méthodes de recherche), on a élaboré une ressource utile pour répondre à un manque observé par les utilisateurs des connaissances. La combinaison des caractéristiques décrites dans le présent article vient combler une lacune dans la procédure utilisée par les cliniciens et les chercheurs désireux d’élaborer des ressources d’information fondées à la fois sur l’expérience et la pratique.
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Affiliation(s)
- Jacqueline Galica
- École des sciences infirmières de l'Université Queen's, Kingston, ON; Institut de recherche sur le cancer de l'Université Queen's, Division d'oncologie et d'épidémiologie; Kingston, ON
| | - Amina Silva
- École des sciences infirmières de l'Université Brock, St. Catharines, ON
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Rognstad K, Engell T, Fjermestad K, Wentzel-Larsen T, Kjøbli J. Process and Implementation Elements of Measurement Feedback Systems: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01325-3. [PMID: 38153585 DOI: 10.1007/s10488-023-01325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/29/2023]
Abstract
Measurement feedback systems (MFS) can help guide treatment and improve clinical outcomes. Studies of MFS are heterogeneous both in execution and results, and the effects of MFS seem restricted by limited attention to process and implementation elements and by limited adoption by health professionals. The current systematic review mapped the use of process and implementation elements in MFS studies. An overview of therapists' use of and attitudes toward MFS is provided. Three-level meta-analyses were used to test theoretically informed process and implementation elements as moderators of the effects of MFS. Hypotheses and general propositions from Clinical Performance Feedback Intervention Theory (CP-FIT) were used to organize the elements of the studies and were used as moderator variables. Previous studies on MFS interventions have had a limited focus on implementation efforts and process elements that may increase the effects of MFS and their use among therapists. Efforts have sparsely been made to reduce barriers to MFS use, and several studies have reported limited engagement with MFS among therapists. Therapists' attitudes toward MFS, feedback, or standardized measures were heterogeneously reported, making data synthesis challenging. Identified process and implementation elements were not significantly associated with effect sizes in the studies and the results did not support the propositions of CP-FIT. The lack of statistically significant associations may be due to limited reporting of details about process and implementation aspects. More research designed to test hypotheses regarding process and implementation elements is needed to improve the use and effects of MFS. Future studies should aspire to report findings in a manner that allows for an understanding of the implementation process and therapists' adoption of these systems.
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Affiliation(s)
- Kristian Rognstad
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Thomas Engell
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | | | - Tore Wentzel-Larsen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - John Kjøbli
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Department of Education, University of Oslo, Oslo, Norway
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Mroz EL, Hernandez-Bigos K, Esterson J, Kiwak E, Naik A, Tinetti ME. Acceptability and use of an online health priorities self-identification tool for older adults: A qualitative investigation. PEC INNOVATION 2023; 3:100242. [PMID: 38161685 PMCID: PMC10757242 DOI: 10.1016/j.pecinn.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/11/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
Objective To examine the use of a web-based, self-directed health priorities identification tool for older adults with multiple chronic conditions (MCCs). Methods We recruited a gender- and racially-diverse, highly educated sample of older adults with MCCs to engage with our My Health Priorities tool, then complete a semi-structured interview. Thematic analysis was used to examine interview transcripts. Results Twenty-one participants shared perspectives on the acceptability and use of the tool. Three themes (with eleven subthemes) were generated to describe: website user experience feedback, the content of the health priorities identification process, and the tool's capacity to empower communication and decision making. Conclusion Participants found this tool acceptable and easy to use, describing a variety of benefits of the priorities self-identification process and offered suggestions for refinement and broader implementation. Older adults with limited internet navigation abilities or misconceptions about the self-directed process may benefit from clinicians clarifying the purpose of the process or initiating priorities-aligned discussions. Innovation This novel tool can help older adults with MCCs define what matters most for their health and healthcare, informing a variety of health decisions. This tool may enable and motivate patients to lead health priorities decision-making discussions with clinicians and care partners.
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Affiliation(s)
- Emily L. Mroz
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Kizzy Hernandez-Bigos
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Jessica Esterson
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Eliza Kiwak
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Aanand Naik
- Institute on Aging, University of Texas Health Science Center, Houston, TX, USA
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mary E. Tinetti
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Foster CC, Kaat AJ, Shah AV, Hodgson CA, Hird-McCorry LP, Janus A, Swanson P, Massey LF, De Sonia A, Cella D, Goodman DM, Davis MM, Laguna TA. Codesign of remote data collection for chronic management of pediatric home mechanical ventilation. Pediatr Pulmonol 2023; 58:3416-3427. [PMID: 37701973 PMCID: PMC10840705 DOI: 10.1002/ppul.26665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Outpatient monitoring of children using invasive home mechanical ventilation (IHMV) is recommended, but access to care can be difficult. This study tested if remote (home-based) data collection was feasible and acceptable in chronic IHMV management. METHODS A codesign study was conducted with an IHMV program, home nurses, and English- and Spanish-speaking parent-guardians of children using IHMV (0-17 years; n = 19). After prototyping, parents used a remote patient monitoring (RPM) bundle to collect patient heart rate, respiratory rate (RR), oxygen saturation, end-tidal carbon dioxide (EtCO2 ), and ventilator pressure/volume over 8 weeks. User feedback was analyzed using qualitative methods and the System Usability Scale (SUS). Expected marginal mean differences within patient measures when awake, asleep, or after a break were calculated using mixed effects models. RESULTS Patients were a median 2.9 years old and 11 (58%) took breaks off the ventilator. RPM data were entered on a mean of 83.7% (SD ± 29.1%) weeks. SUS scores were 84.8 (SD ± 10.5) for nurses and 91.8 (SD ± 10.1) for parents. Over 90% of parents agreed/strongly agreed that RPM data collection was feasible and relevant to their child's care. Within-patient comparisons revealed that EtCO2 (break-vs-asleep 2.55 mmHg, d = 0.79 [0.42-1.15], p < .001; awake-vs-break 1.48, d = -0.49 [0.13-0.84], p = .02) and RR (break-vs-asleep 16.14, d = 2.12 [1.71-2.53], p < .001; awake-vs-break 3.44, d = 0.45 [0.10-0.04], p = .03) were significantly higher during ventilator breaks. CONCLUSIONS RPM data collection in children with IHMV was feasible, acceptable, and captured clinically meaningful vital sign changes during ventilator breaks, supporting the clinical utility of RPM in IHMV management.
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Affiliation(s)
- Carolyn C. Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Digital Health, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | | | - Avani V. Shah
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Caroline A. Hodgson
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | | | - Angela Janus
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Philip Swanson
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Liana F. Massey
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Anna De Sonia
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - David Cella
- Departments of Medicine, Medical Social Sciences
| | - Denise M. Goodman
- Pulmonary Habilitation Program, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Matthew M. Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine
- Mary Ann & J. Milburn Smith Child Health Outcomes Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Departments of Medicine, Medical Social Sciences
| | - Theresa A. Laguna
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine
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Moldestad M, Petrova VV, Tirtanadi K, Mishra SR, Rajan S, Sayre G, Fortney JC, Reisinger HS. Improving the Usability of Written Exposure Therapy for Therapists in the Department of Veterans Affairs Telemental Health: Formative Study Using Qualitative and User-Centered Design Methods. JMIR Form Res 2023; 7:e47189. [PMID: 37930747 PMCID: PMC10660215 DOI: 10.2196/47189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND User modifications are common in evidence-based psychosocial interventions (EBPIs) for mental health disorders. Often, EBPIs fit poorly into clinical workflows, require extensive resources, or pose considerable burden to patients and therapists. Implementation science is increasingly researching ways to improve the usability of EBPIs before implementation. A user-centered design can be used to support implementation methods to prioritize user needs and solutions to improve EBPI usability. OBJECTIVE Trauma-focused EBPIs are a first-line treatment for patients with posttraumatic stress disorder (PTSD) in the Department of Veterans Affairs. Written exposure therapy (WET) is a brief, trauma-focused EBPI wherein patients handwrite about trauma associated with their PTSD. Initially developed for in-person delivery, WET is increasingly being delivered remotely, and outcomes appear to be equivalent to in-person delivery. However, there are logistical issues in delivering WET via video. In this evaluation, we explored usability issues related to WET telehealth delivery via videoconferencing software and designed a solution for therapist-facing challenges to systematize WET telehealth delivery. METHODS The Discover, Design and Build, and Test framework guided this formative evaluation and served to inform a larger Virtual Care Quality Enhancement Research Initiative. We used qualitative descriptive methods in the Discover phase to understand the experiences and needs of 2 groups of users providing care within the Department of Veterans Affairs: in-person therapists delivering WET via video because of the COVID-19 pandemic and telehealth therapists who regularly deliver PTSD therapies. We then used user-centered design methods in the Design and Build phase to brainstorm, develop, and iteratively refine potential workflows to address identified usability issues. All procedures were conducted remotely. RESULTS In the Discover phase, both groups had challenges delivering WET and other PTSD therapies via telehealth because of technology issues with videoconferencing software, environmental distractions, and workflow disruptions. Narrative transfer (ie, patients sending handwritten trauma accounts to therapists) was the first target for design solution development as it was deemed most critical to WET delivery. In the Design and Build phase, we identified design constraints and brainstormed solution ideas. This led to the development of 3 solution workflows that were presented to a subgroup of therapist users through cognitive walkthroughs. Meetings with this subgroup allowed workflow refinement to improve narrative transfers. Finally, to facilitate using these workflows, we developed PDF manuals that are being refined in subsequent phases of the implementation project (not mentioned in this paper). CONCLUSIONS The Discover, Design and Build, and Test framework can be a useful tool for understanding user needs in complex EBPI interventions and designing solutions to user-identified usability issues. Building on this work, an iterative evaluation of the 3 solution workflows and accompanying manuals with therapists and patients is underway as part of a nationwide WET implementation in telehealth settings.
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Affiliation(s)
- Megan Moldestad
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Valentina V Petrova
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Katie Tirtanadi
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Sonali R Mishra
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Suparna Rajan
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
| | - George Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
- School of Public Health, University of Washington, Seattle, WA, United States
| | - John C Fortney
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle, WA, United States
| | - Heather Schacht Reisinger
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
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Aneni K, Fernandes CSF, Hoerner LA, Szapary C, Pendergrass Boomer TM, Fiellin LE. A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study. JMIR Serious Games 2023; 11:e46912. [PMID: 37921851 PMCID: PMC10656656 DOI: 10.2196/46912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/31/2023] [Accepted: 09/08/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health. OBJECTIVE This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial. METHODS We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart. RESULTS We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings. CONCLUSIONS PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner.
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Affiliation(s)
- Kammarauche Aneni
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
- Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
| | - Claudia-Santi F Fernandes
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
- Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
| | - Lily A Hoerner
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Claire Szapary
- Yale School of Public Health, New Haven, CT, United States
| | | | - Lynn E Fiellin
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
- Yale School of Public Health, New Haven, CT, United States
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Hogue A, MacLean A, Bobek M, Porter N, Bruynesteyn L, Jensen-Doss A, Henderson CE. Pilot Trial of Online Measurement Training and Feedback in Family Therapy for Adolescent Behavior Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:850-865. [PMID: 35384750 PMCID: PMC9535038 DOI: 10.1080/15374416.2022.2051529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pragmatic procedures for sustaining high-fidelity delivery of evidence-based interventions are needed to support implementation in usual care. This study tested an online therapist training system, featuring observational coder training and self-report fidelity feedback, to promote self-report acumen and routine use of family therapy (FT) techniques for adolescent behavior problems. METHOD Therapists (N = 84) from nine substance use and mental health treatment sites reported on 185 adolescent clients. Therapists submitted baseline data on FT technique use with clients, completed a workshop introducing the 32-week training system, and were randomly assigned by site to Core Training versus Core Training + Consultation. Core Training included a therapist coder training course (didactic instruction and mock session coding exercises in 13 FT techniques) and fidelity feedback procedures depicting therapist-report data on FT use. Consultation convened therapists and supervisors for one-hour monthly sessions with an external FT expert. During the 32 weeks of training, therapists submitted self-report data on FT use along with companion session audiotapes subsequently coded by observational raters. RESULTS Therapist self-report reliability and accuracy both increased substantially during training. Observers reported no increase over time in FT use; therapists self-reported a decrease in FT use, likely an artifact of their improved self-report accuracy. Consultation did not enhance therapist self-report acumen or increase FT use. CONCLUSIONS Online training methods that improve therapist-report reliability and accuracy for FT use may confer important advantages for treatment planning and fidelity monitoring. More intensive and/or different training interventions appear needed to increase routine FT delivery.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Alexandra MacLean
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Nicole Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Lila Bruynesteyn
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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Wang L, Yuwen W, Hua W, Chen L, Forsythe Cox V, Zheng H, Ning Z, Zhao Z, Liu Z, Jiang Y, Li X, Guo Y, Simoni JM. Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy-Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach. JMIR Form Res 2023; 7:e47903. [PMID: 37831497 PMCID: PMC10611999 DOI: 10.2196/47903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. OBJECTIVE This study aims to systematically describe the development of a mobile health-based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. METHODS We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. RESULTS The dialectical behavior therapy (DBT)-informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user's mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. CONCLUSIONS This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Weichao Yuwen
- School of Nursing & Healthcare Leadership, University of Washington, Tacoma, Tacoma, WA, United States
| | - Wenzhe Hua
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lingxiao Chen
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, United States
| | - Vibh Forsythe Cox
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Huang Zheng
- Shanghai China Sex Worker & Men who have Sex with Men Center, Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Zhuojun Zhao
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Zhaoyu Liu
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Yunzhang Jiang
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States
| | - Xinran Li
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Yawen Guo
- Information School, University of Washington, Seattle, WA, United States
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
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Vamos CA, Cayama MR, Mahony H, Griner SB, Quinonez RB, Boggess K, Beckstead J, Daley EM. Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers. BMC Pregnancy Childbirth 2023; 23:721. [PMID: 37821843 PMCID: PMC10566079 DOI: 10.1186/s12884-023-06032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types. METHODS Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS. RESULTS Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers. CONCLUSIONS Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.
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Affiliation(s)
- Cheryl A Vamos
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA.
| | - Morgan Richardson Cayama
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA
| | - Helen Mahony
- College of Social Sciences and Public Policy, Florida State University, 113 Collegiate Loop, Tallahassee, FL, 32304, USA
| | - Stacey B Griner
- School of Public Health, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd Fort Worth, Fort Worth, TX, 76107, USA
| | - Rocio B Quinonez
- Division of Pediatric Dentistry and Public Health, Department of Pediatrics, Schools of Dentistry and Medicine, University of North Carolina at Chapel Hill, 385 S. Columbia St., Chapel Hill, NC, 27599, USA
| | - Kim Boggess
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, Campus Box 7570, Chapel Hill, NC, 27599, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA
| | - Ellen M Daley
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd MDC 56, Tampa, FL, 33612, USA
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Shaffer KM, Daniel KE, Frederick C, Buysse DJ, Morin CM, Ritterband LM. Online sleep diaries: considerations for system development and recommendations for data management. Sleep 2023; 46:zsad199. [PMID: 37480840 PMCID: PMC11009686 DOI: 10.1093/sleep/zsad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/15/2023] [Indexed: 07/24/2023] Open
Abstract
STUDY OBJECTIVES To present development considerations for online sleep diary systems that result in robust, interpretable, and reliable data; furthermore, to describe data management procedures to address common data entry errors that occur despite those considerations. METHODS The online sleep diary capture component of the Sleep Healthy Using the Internet (SHUTi) intervention has been designed to promote data integrity. Features include diary entry restrictions to limit retrospective bias, reminder prompts and data visualizations to support user engagement, and data validation checks to reduce data entry errors. Despite these features, data entry errors still occur. Data management procedures relying largely on programming syntax to minimize researcher effort and maximize reliability and replicability. Presumed data entry errors are identified where users are believed to have incorrectly selected a date or AM versus PM on the 12-hour clock. Following these corrections, diaries are identified that have unresolvable errors, like negative total sleep time. RESULTS Using the example of one of our fully-powered, U.S. national SHUTi randomized controlled trials, we demonstrate the application of these procedures: of 45,598 total submitted diaries, 487 diaries (0.01%) required modification due to date and/or AM/PM errors and 27 diaries (<0.001%) were eliminated due to unresolvable errors. CONCLUSION To secure the most complete and valid data from online sleep diary systems, it is critical to consider the design of the data collection system and to develop replicable processes to manage data. CLINICAL TRIAL REGISTRATION Sleep Healthy Using The Internet for Older Adult Sufferers of Insomnia and Sleeplessness (SHUTiOASIS); https://clinicaltrials.gov/ct2/show/NCT03213132; ClinicalTrials.gov ID: NCT03213132.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Katharine E Daniel
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Christina Frederick
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Daniel J Buysse
- Sleep Medicine Institute and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Charles M Morin
- School of Psychology and CERVO/BRAIN Research Center, Laval University, Québec, QC, Canada
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Ishikawa SI, Kishida K, Takahashi T, Fujisato H, Urao Y, Matsubara K, Sasagawa S. Cultural Adaptation and Implementation of Cognitive-Behavioral Psychosocial Interventions for Anxiety and Depression in Japanese Youth. Clin Child Fam Psychol Rev 2023; 26:727-750. [PMID: 37500948 DOI: 10.1007/s10567-023-00446-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
The present article reviews the current status of cognitive-behavioral therapy (CBT) interventions for anxiety and depression in Japanese youth. First, a literature review of youth CBT programs for anxiety and depression is provided. Through this process, we identify which program/protocol has been most researched within Japan. Second, through a systematic interview to the authors, the development process of four predominant programs is outlined. The programs included were a family CBT program for anxiety disorders (the Japanese Anxiety Children/Adolescents Cognitive Behavior Therapy program), two school-based prevention programs for anxiety and depression (Journey of the Brave and Phoenix Time), and a transdiagnostic protocol for anxiety and depression (Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents). Third, cultural adaptation and modification of the programs are discussed from the scope of user-centered design principles as described by Lyon and Koerner (Sci Pract 23:180-200, 2016). As a result, changes in program content and material, as represented by the use of culture-friendly program names, acronyms, illustrations, and characters were endorsed in all of the programs. Structured but flexible session formats helped increase learnability and efficiency while keeping the cognitive load of providers and consumers low. A careful selection of providers, as well as quality training and consultation are important factors to maximize competency and ensure appropriate implementation. Application of existing time frames and staff who work in each setting were effective ways to increase scalability. Overall, it was shown that many of the modifications adopted overlap among successful programs; these represent the most basic and essential requirements for a program to be applicable to a wide range of contexts. Implications and further directions are explored.
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Affiliation(s)
- Shin-Ichi Ishikawa
- Faculty of Psychology, Doshisha University, 1-3 Tatara Miyakodani, Kyotanabe, Kyoto, 610-0394, Japan.
| | - Kohei Kishida
- Japan Society for the Promotion of Science, Tokyo, Japan
- Kwansei Gakuin University, Hyogo, Japan
| | | | | | | | - Kohei Matsubara
- Faculty of Psychology, Doshisha University, 1-3 Tatara Miyakodani, Kyotanabe, Kyoto, 610-0394, Japan
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Tadros M, Li S, Upton E, Newby J, Werner-Seidler A. Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study. JMIR Hum Factors 2023; 10:e44145. [PMID: 37616036 PMCID: PMC10485721 DOI: 10.2196/44145] [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: 11/08/2022] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. OBJECTIVE This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. METHODS Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. RESULTS In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. CONCLUSIONS Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.
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Affiliation(s)
- Michelle Tadros
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Sophie Li
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Emily Upton
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Jill Newby
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
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Monnet F, Dupont C, Smets T, De Vleminck A, Van Audenhove C, Van den Block L, Pivodic L. Advance Care Planning Website for People With Dementia and Their Family Caregivers: Protocol for a Development and Usability Study. JMIR Res Protoc 2023; 12:e46935. [PMID: 37494084 PMCID: PMC10413243 DOI: 10.2196/46935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Web-based tools for people with dementia and their family caregivers have considerably increased over the years and offer promising solutions to several unmet needs such as supporting self-care in daily life, facilitating treatment delivery, or ensuring their ability to communicate. The use of web-based tools in the field of advance care planning (ACP) for people with dementia and their family caregivers has yet to be explored and requires careful consideration, given the sensitive topic and the specific needs of people with dementia and their families. OBJECTIVE This paper reports the protocol for a study aiming to develop and simultaneously test the usability of an ACP website designed for, and with, people with dementia and their families. METHODS The development of the website is based on a process map for the development of web-based decision support interventions and on the Medical Research Council framework for complex intervention development and evaluation. Additionally, we apply a user-centered approach in combination with patient and public involvement (PPI) throughout the development process. We describe our iterative development approach to the website. Participants and a PPI group give feedback on 4 prototypes of the ACP website. For each iteration, we aim to include 12 participants (3 people with dementia, 3 family caregivers, and 3 dyads) in usability testing. In the first 3 iterations, usability testing includes (1) a think-aloud exercise, (2) researcher observations, and (3) the System Usability Scale questionnaire. The last iteration of usability testing is composed of a semistructured interview assessing the layout, content, face validity, and readability of the website. Qualitative data from the think-aloud exercises and interviews are analyzed using thematic analysis. Mean scores are calculated for the System Usability Scale questionnaire. RESULTS This study received approval from the Ethical Review Board of Brussels University Hospital of the Vrije Universiteit Brussel. Recruitment began in October 2021. The target date for paper submission of the results of the development and usability testing will be in 2023. CONCLUSIONS The methods in this protocol describe a feasible and inclusive approach to the development of an ACP website together with people with dementia, their family caregivers, and other stakeholders. We provide a clear overview of how to combine PPI input and user-centered development methods, leading to a transparent and reliable development process. This protocol might stimulate the active participation of people with dementia, their caregivers, and regional stakeholders in future studies on web-based technologies. The results of this study will be used to refine the design and create a relevant and user-friendly ACP website that is ready to be tested in a larger evaluation study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46935.
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Affiliation(s)
- Fanny Monnet
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Charlèss Dupont
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
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Hogue A, Bobek M, Porter N, Dauber S, Southam-Gerow MA, McLeod BD, Henderson CE. Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:490-502. [PMID: 34519608 PMCID: PMC8918434 DOI: 10.1080/15374416.2021.1969939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. METHOD The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. RESULTS Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach's α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. CONCLUSIONS Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Molly Bobek
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Nicole Porter
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Sarah Dauber
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | | | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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Wexler C, Dixon KS, Oyowe K, Lapke B, Conner H, Shoemaker H, Corriveau E, Greiner A, Finocchario-Kessler S. Development and evaluation of a COVID tracking system to support provision of social service in Wyandotte County, Kansas. Front Public Health 2023; 11:1035319. [PMID: 37427281 PMCID: PMC10326267 DOI: 10.3389/fpubh.2023.1035319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
Background In addition to the state-mandated case investigation and contact tracing, the Unified Government Public Health Department of Wyandotte County, Kansas implemented social support services for COVID-19 cases and contacts; however, did not have the systems in place to document the provision of these services. Our team worked with the health department to develop and implement the COVID Tracking System (CTS), an eHealth system that linked multiple involved teams. Here, we describe the development and evaluation of the CTS. The objective of this manuscript is to describe and evaluate the development and implementation process of the Covid Tracking System. Methods Drawing from concepts of user-centered design, we took a 4-phase approach to development: understanding context, specifying needs, designing solutions, and evaluating. A mixed-methods evaluation of the development and implementation process using RE-AIM was conducted. Quantitative CTS data captured between February 1, 2021, and September 30, 2021 were exported. Descriptive statistics were calculated for categorical variables and means (SD, range) or median (IQR) for continuous variables. Qualitative discussions with key users supplemented the quantitative data. Results There were 1,152 cases entered into the CTS, of whom 307 (26.6%) requested a letter be sent to their workplace to excuse them during their quarantine period, 817 (70.9%) requested and had food and cleaning supplies delivered, 21 (1.8%) requested guidance on applying for federal assistance, and 496 (43.1%) requested to be contacted by a community health worker. While a few technical glitches slowed down early implementation, these were quickly resolved and key users felt that the CTS streamlined client referral and simplified their workflow, allowing them to spend more time on patient care and follow up, rather than documentation. After study implementation ended, the Unified Government Public Health Department of Wyandotte County continued using the CTS for client tracing and follow up. Discussion This project provides a roadmap of how user centered design can be applied to the development and evaluation of eHealth software to support program intervention implementation, even in situations where urgent action is needed.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Katelyn Sanner Dixon
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kevin Oyowe
- Global Health Innovations–Kenya, Nairobi, Kenya
| | - Brooke Lapke
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Hannah Conner
- Unified Government of Wyandotte County Health Department, Kansas City, KS, United States
| | - Hailey Shoemaker
- Unified Government of Wyandotte County Health Department, Kansas City, KS, United States
| | - Erin Corriveau
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- Unified Government of Wyandotte County Health Department, Kansas City, KS, United States
| | - Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- Unified Government of Wyandotte County Health Department, Kansas City, KS, United States
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Rouleau G, Thiruganasambandamoorthy V, Wu K, Ghaedi B, Nguyen PA, Desveaux L. Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid Physicians in the Clinical Management of Patients With Syncope: Systematic Theoretical and User-Centered Design Approach. JMIR Hum Factors 2023; 10:e44089. [PMID: 37310783 DOI: 10.2196/44089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The Canadian Syncope Risk Score (CSRS) was developed to improve syncope management in emergency department settings. Evidence-based tools often fail to have the intended impact because of suboptimal uptake or poor implementation. OBJECTIVE In this paper, we aimed to describe the process of developing evidence-based implementation strategies to support the deployment and use of the CSRS in real-world emergency department settings to improve syncope management among physicians. METHODS We followed a systematic approach for intervention development, including identifying who needs to do what differently, identifying the barriers and enablers to be addressed, and identifying the intervention components and modes of delivery to overcome the identified barriers. We used the Behaviour Change Wheel to guide the selection of implementation strategies. We engaged CSRS end users (ie, emergency medicine physicians) in a user-centered design approach to generate and refine strategies. This was achieved over a series of 3 qualitative user-centered design workshops lasting 90 minutes each with 3 groups of emergency medicine physicians. RESULTS A total of 14 physicians participated in the workshops. The themes were organized according to the following intervention development steps: theme 1-identifying and refining barriers and theme 2-identifying the intervention components and modes of delivery. Theme 2 was subdivided into two subthemes: (1) generating high-level strategies and developing strategies prototypes and (2) refining and testing strategies. The main strategies identified to overcome barriers included education in the format of meetings, videos, journal clubs, and posters (to address uncertainty around when and how to apply the CSRS); the development of a web-based calculator and integration into the electronic medical record (to address uncertainty in how to apply the CSRS); a local champion (to address the lack of team buy-in); and the dissemination of evidence summaries and feedback through email communications (to address a lack of evidence about impact). CONCLUSIONS The ability of the CSRS to effectively improve patient safety and syncope management relies on broad buy-in and uptake across physicians. To ensure that the CSRS is well positioned for impact, a comprehensive suite of strategies was identified to address known barriers.
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Affiliation(s)
- Geneviève Rouleau
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Nursing Department, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada
| | - Kelly Wu
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Bahareh Ghaedi
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada
| | - Phuong Anh Nguyen
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada
| | - Laura Desveaux
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Braddock WRT, Ocasio MA, Comulada WS, Mandani J, Fernandez MI. Increasing Participation in a TelePrEP Program for Sexual and Gender Minority Adolescents and Young Adults in Louisiana: Protocol for an SMS Text Messaging-Based Chatbot. JMIR Res Protoc 2023; 12:e42983. [PMID: 37256669 PMCID: PMC10267782 DOI: 10.2196/42983] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/13/2023] [Accepted: 03/23/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Sexual and gender minority (SGM) adolescents and young adults (AYAs) are at increased risk of HIV infection, particularly in the Southern United States. Despite the availability of effective biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP), access and uptake remain low among SGM AYAs. In response, the Louisiana Department of Health initiated the LA TelePrEP Program, which leverages the power of telemedicine to connect Louisiana residents to PrEP. A virtual TelePrEP Navigator guides users through the enrollment process, answers questions, schedules appointments, and facilitates lab testing and medication delivery. To increase the participation of SGM AYAs in the program, the TelePrEP program partnered with researchers to develop a chatbot that would facilitate access to the program and support navigator functions. Chatbots are capable of carrying out many functions that reduce employee workload, and despite their successful use in health care and public health, they are relatively new to HIV prevention. OBJECTIVE In this paper, we describe the iterative and community-engaged process that we used to develop an SMS text messaging-based chatbot tailored to SGM AYAs that would support navigator functions and disseminate PrEP-related information. METHODS Our process was comprised of 2 phases: conceptualization and development. In the conceptualization phase, aspects of navigator responsibilities, program logistics, and user interactions to prioritize in chatbot programming (eg, scheduling appointments and answering questions) were identified. We also selected a commercially available chatbot platform that could execute these functions and could be programmed with minimal coding experience. In the development phase, we engaged Department of Health staff and SGM AYAs within our professional and personal networks. Five different rounds of testing were conducted with various groups to evaluate each iteration of the chatbot. After each iteration of the testing process, the research team met to discuss feedback, guide the programmer on incorporating modifications, and re-evaluate the chatbot's functionality. RESULTS Through our highly collaborative and community-engaged process, a rule-based chatbot with artificial intelligence components was successfully created. We gained important knowledge that could advance future chatbot development efforts for HIV prevention. Key to the PrEPBot's success was resolving issues that hampered the user experience, like asking unnecessary questions, responding too quickly, and misunderstanding user input. CONCLUSIONS HIV prevention researchers can feasibly and efficiently program a rule-based chatbot with the assistance of commercially available tools. Our iterative process of engaging researchers, program personnel, and different subgroups of SGM AYAs to obtain input was key to successful chatbot development. If the results of this pilot trial show that the chatbot is feasible and acceptable to SGM AYAs, future HIV researchers and practitioners could consider incorporating chatbots as part of their programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/42983.
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Affiliation(s)
| | - Manuel A Ocasio
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - W Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jan Mandani
- Office of Public Health, Louisiana Department of Health, New Orleans, LA, United States
| | - M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
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Ming DY, Zhao C, Tang X, Chung RJ, Rogers UA, Stirling A, Economou-Zavlanos NJ, Goldstein BA. Predictive Modeling to Identify Children With Complex Health Needs At Risk for Hospitalization. Hosp Pediatr 2023; 13:357-369. [PMID: 37092278 PMCID: PMC10158078 DOI: 10.1542/hpeds.2022-006861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Identifying children at high risk with complex health needs (CCHN) who have intersecting medical and social needs is challenging. This study's objectives were to (1) develop and evaluate an electronic health record (EHR)-based clinical predictive model ("model") for identifying high-risk CCHN and (2) compare the model's performance as a clinical decision support (CDS) to other CDS tools available for identifying high-risk CCHN. METHODS This retrospective cohort study included children aged 0 to 20 years with established care within a single health system. The model development/validation cohort included 33 months (January 1, 2016-September 30, 2018) and the testing cohort included 18 months (October 1, 2018-March 31, 2020) of EHR data. Machine learning methods generated a model that predicted probability (0%-100%) for hospitalization within 6 months. Model performance measures included sensitivity, positive predictive value, area under receiver-operator curve, and area under precision-recall curve. Three CDS rules for identifying high-risk CCHN were compared: (1) hospitalization probability ≥10% (model-predicted); (2) complex chronic disease classification (using Pediatric Medical Complexity Algorithm [PMCA]); and (3) previous high hospital utilization. RESULTS Model development and testing cohorts included 116 799 and 27 087 patients, respectively. The model demonstrated area under receiver-operator curve = 0.79 and area under precision-recall curve = 0.13. PMCA had the highest sensitivity (52.4%) and classified the most children as high risk (17.3%). Positive predictive value of the model-based CDS rule (19%) was higher than CDS based on the PMCA (1.9%) and previous hospital utilization (15%). CONCLUSIONS A novel EHR-based predictive model was developed and validated as a population-level CDS tool for identifying CCHN at high risk for future hospitalization.
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Affiliation(s)
- David Y. Ming
- Departments of Pediatrics
- Medicine
- Population Health Sciences
| | | | - Xinghong Tang
- Janssen Research & Development, LLC, Raritan, New Jersey
| | | | - Ursula A. Rogers
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | - Andrew Stirling
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | | | - Benjamin A. Goldstein
- Departments of Pediatrics
- Population Health Sciences
- Biostatistics & Bioinformatics, and
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Eiraldi R, Comly R, Goldstein J, Khanna MS, McCurdy BL, Rutherford LE, Henson K, Bevenour P, Francisco J, Jawad AF. Development of an Online Training Platform and Implementation Strategy for School-Based Mental Health Professionals in Rural Elementary Schools: A Mixed-Methods Study. SCHOOL MENTAL HEALTH 2023; 15:1-18. [PMID: 37359158 PMCID: PMC10069346 DOI: 10.1007/s12310-023-09582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
Children in rural settings are less likely to receive mental health services than their urban and suburban counterparts and even less likely to receive evidence-based care. Rural schools could address the need for mental health interventions by using evidence-based practices within a tiered system of supports such as positive behavioral interventions and supports. However, very few school professionals, with or without mental health training, have received training on evidence-based practices. Rural schools need implementation strategies focused on training to prepare school personnel for the implementation of interventions with fidelity. Little is known about training strategies that are feasible and appropriate for the rural school context. User-centered design is an appropriate framework for the development of training strategies for professionals in rural schools because of its participatory approach and the development of products that fit the context where they are going to be used. The purpose of the study was to develop and assess components of an online training platform and implementation strategy based on the user-centered design. Quantitative and qualitative data from 25 participants from an equal number of schools in rural areas of Pennsylvania were used in the study. A mixed-methods design utilizing complementary descriptive statistics and theme analyses indicated that the training platform and implementation strategy were perceived as highly acceptable, appropriate, feasible and usable by school professionals. The resulting training platform and implementation strategy will fill a void in the training literature in rural schools.
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Affiliation(s)
- Ricardo Eiraldi
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Rachel Comly
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | - Jessica Goldstein
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | | | - Barry L. McCurdy
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131 USA
| | | | - Kathryn Henson
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | - Patrick Bevenour
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | | | - Abbas F. Jawad
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
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Mavragani A, Johnson C, Kiche S, Dastrup K, Nguyen J, Daniels A, Mbwayo A, Amanya C, Munson S, Collins PY, Weiner BJ, Dorsey S. Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study. JMIR Form Res 2023; 7:e38822. [PMID: 36729591 PMCID: PMC9936369 DOI: 10.2196/38822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered. OBJECTIVE Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision. METHODS Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants' choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis. RESULTS Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support. CONCLUSIONS Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s43058-020-00102-9.
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Affiliation(s)
| | - Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Sharon Kiche
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Kara Dastrup
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Julie Nguyen
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Alayna Daniels
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Sean Munson
- Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of of Health Services, University of Washington, Seattle, WA, United States
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
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48
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Tilley MA, Montreuil T. Acceptability, implementation, and perceived utility of a school‐based cognitive‐behavioral intervention: A qualitative feasibility study. PSYCHOLOGY IN THE SCHOOLS 2023. [DOI: 10.1002/pits.22870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Micah A. Tilley
- Department of Educational and Counselling Psychology, Faculty of Education McGill University Quebec Canada
| | - Tina Montreuil
- Department of Educational and Counselling Psychology, Faculty of Education McGill University Quebec Canada
- Department of Psychiatry, Faculty of Medicine and Health Sciences McGill University Quebec Canada
- Research Institute, McGill University Health Centre Quebec Canada
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49
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Shkel J, Green G, Le S, Kaveladze B, Marcotte V, Rushton K, Nguyen T, Schueller SM. Understanding Users’ Experiences of a Novel Online Cognitive-Behavioral Therapy Platform for Depression and Anxiety: Qualitative Interviews from Pilot Trial Participants (Preprint). JMIR Form Res 2023. [DOI: 10.2196/46062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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50
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Yakovchenko V, Rogal SS, Goodrich DE, Lamorte C, Neely B, Merante M, Gibson S, Scott D, McCurdy H, Nobbe A, Morgan TR, Chinman MJ. Getting to implementation: Adaptation of an implementation playbook. Front Public Health 2023; 10:980958. [PMID: 36684876 PMCID: PMC9853037 DOI: 10.3389/fpubh.2022.980958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Implementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt "Getting To Outcomes"® (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into "Getting To Implementation" (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings. Methods Our embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period. Results Adaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer. Conclusion GTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data. Trial registration This study was registered on ClinicalTrials.gov (Identifier: NCT04178096).
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Affiliation(s)
- Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - David E. Goodrich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Brittney Neely
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Monica Merante
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dawn Scott
- Department of Medicine, Central Texas Veterans Healthcare System, Temple, TX, United States
| | - Heather McCurdy
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Anna Nobbe
- Digestive Disease Section, Cincinnati VA Medical Center, Cincinnati, OH, United States
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, United States
- Division of Gastroenterology, Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Matthew J. Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- RAND Corporation, Pittsburgh, PA, United States
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