The role of motivation in clinical presentation, treatment engagement and response in schizophrenia-spectrum disorders: A systematic review

Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.

Long-Term Effects of the Multicomponent Program BrainProtect® on Cognitive Function: One-Year Follow-Up in Healthy Adults

Background

Age-related neuronal changes impact cognitive integrity, which is a major contributor to health and quality of life. The best strategy to prevent cognitive decline and Alzheimer's disease is still debated.

Objective

To investigate the long-term effects of the eight-week multicomponent training program BrainProtect® on cognitive abilities compared to general health counseling (GHC) in cognitively healthy adults in Germany.

Methods

Healthy adults (age ≥50 years) previously randomized to either GHC (n = 72) or BrainProtect (intervention group, IG, n = 60) for eight-weeks (once weekly, 90 minutes, group-based) underwent a comprehensive neuropsychological test battery and health-related quality of life (HRQoL) evaluation 3- and 12-months after intervention end.

Results

Dropout rates were n = 8 after 3 months and n = 19 after 12 months. No significant long-term effect of BrainProtect was observed for the primary endpoint Consortium to Establish a Registry for Alzheimer's Disease (CERAD-Plus) total score. Logical reasoning was significantly improved (p = 0.024) 12 months after completion of the training program in IG participants compared to the GHC group independent of sex, age, education, diet, and physical activity. In IG participants, thinking flexibility (p = 0.019) and confrontational naming (p = 0.010) were improved 3 months after completing the intervention compared to the GHC group, however, after conservative Bonferroni adjustment, significance was lost.

Conclusions

BrainProtect® independently improved logical reasoning compared to GHC up to 12 months after cognitive training's end in healthy adults. To uncover the long-term clinical significance of multicomponent cognitive training in healthy adults, studies with larger sample size and frequent follow up visits are necessary.

Needs, Modes, and Stances: Three Cardinal Questions for Psychotherapy Practice and Training

Background

Advances in motivational science (Dweck, 2017), personality dynamics (Lazarus & Rafaeli, 2023), and process-based psychotherapy (Hofmann & Hayes, 2019) converge into a pragmatic, integrative, and transtheoretical model of practice and training.

Method

The model comprises three elements: a formulation centered on clients' psychological needs which provides guidance regarding the goals and processes most profitable to pursue; a recognition that such pursuit frequently requires contending with a multiplicity of clients' internal self-states (i.e., modes); and an enumeration of pragmatic therapeutic stances likely to help address clients' need-related goals in light of their modes.

Results

We distill these elements into three cardinal questions: What needs does this client have that are not currently met, and what are the most profitable ways of remedying that frustration? What mode or modes does this client manifest - both generally and at this very moment? and What stance should I adopt in response to the client's current mode? We suggest that clinicians should be trained to continually pose these questions and seek to answer them collaboratively with their clients.

Conclusion

This model - illustrated here using schema therapy terms - offers a process-based approach which serves as a theoretically integrative starting point but is general enough to provide an assimilative integration roadmap for therapists anchored in most primary orientations. Integrative or assimilative therapists trained to attend to needs, modes, and stances are likely to be (and be perceived as) particularly responsive, and thus, to enact "common factor" practices known to be conducive to therapeutic alliance and gains.

Dropout From Exercise Interventions in Adults With Knee or Hip Osteoarthritis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the prevalence and moderators of dropout rates among adults with knee or hip osteoarthritis participating in exercise randomized controlled trials (RCTs).

DATA SOURCES

Two authors searched Embase, CINAHL, PsycARTICLES, and PubMed up to 01/09/2023.

STUDY SELECTION

We included RCTs of exercise interventions in people with knee or hip osteoarthritis that reported dropout rates.

DATA EXTRACTION

Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related moderators.

DATA SYNTHESIS

In total, 209 RCTs involving 277 exercise arms in 13,102 participants were included (mean age at study level=64 years; median prevalence of men participants=26.8%). The trim-and-fill-adjusted prevalence of dropout across all RCTs was 17.5% (95% CI=16.7%-18.2%), which is comparable with dropout observed in control conditions (trim-and-fill-adjusted odds ratio=0.89; 95% CI=0.71-1.12, P=.37). Higher prevalence of antidepressant use at study-level predicted higher dropout (R2=0.75, P=.002, N RCTs=6, n exercisers=412). Supervision by an exercise professional was associated with lower dropout rates, with a trim-and-fill-adjusted rate of 13.2% (95% CI=11.7%-14.9%) compared with 20.8% without supervision (95% CI=18.3%-23.5%) (P<.001).

CONCLUSIONS

Dropout rates for exercise in RCTs are comparable with control conditions, suggesting that exercise is a generally well-accepted intervention. However, interventions should be supervised by an exercise professional, such as a physiotherapist or exercise physiologist, to further minimize the risk of dropout. Health professionals should consider participants' use of antidepressants as a risk factor for dropout from exercise.

Risk perception as a motivational resource during the COVID-19 pandemic: the role of vaccination status and emerging variants

BACKGROUND

People's perceived risk of being infected and having severe illness was conceived as a motivational source of adherence to behavioral measures during the COVID-19 crisis.

METHODS

We used online self-reported data, spanning 20 months of the COVID-19 crisis in Belgium (n = 221,791; 34.4% vaccinated; July 2020 - March 2022) to study the association between risk perception and motivation.

RESULTS

Both perceived infection probability and severity fluctuated across time as a function of the characteristics of emerging variants, with unvaccinated persons perceiving decreasingly less risk compared to vaccinated ones. Perceived severity (and not perceived probability) was the most critical predictor of autonomous motivation for adherence to health-protective measures, a pattern observed at both the between-day and between-person level among both vaccinated and unvaccinated individuals. An integrated process model further indicated that on days with higher hospitalization load, participants reported being more adherent because risk severity and autonomous motivation for adherence were more elevated on these days.

CONCLUSIONS

These findings suggest that risk severity served as a critical and dynamic resource for adherence to behavioral measures because it fostered greater autonomous regulation.

Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program

Medical students are at elevated risk for mental health difficulties and may struggle to ask for help. Innovative outreach programs are warranted to reduce barriers and ensure that students receive the professional care they need and deserve. This article provides a 6-year retrospective of the Keck Checks program, a well-established initiative that offered universal 15-minute mental health screenings to every first-year medical student at the Keck School of Medicine of the University of Southern California from fall 2016 to fall 2022. This early detection program was designed to combat barriers to seeking mental health care by normalizing the concept of all students meeting with a psychologist early in their academic careers. The Keck Checks program showed promising feasibility, with a single full-time clinician successfully hosting appointments for entire classes of first-year medical students (mean of 189 students per class) during approximately 4 months, in addition to other work duties. Participation rates were high, with 715 eligible students (76.3%) choosing to attend their Keck Check. Students were frequently referred to follow-up services during the Keck Check, including mental health care (n = 360 [50.4%] referred), occupational therapy (n = 72 [10.1%] referred), and academic support services (n = 60 [8.4%] referred). Next steps include possible expansion of similar programs to medical students in years 2 to 4, residents, and physicians, as well as understanding the effect of brief mental health screenings on long-term help-seeking, adherence to mental health treatment plans, and general educational or professional success. Brief, universal mental health screenings are a relatively low-cost, high-impact approach for medical schools to consider in supporting the mental health of their student body.

The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis

BACKGROUND

Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain.

METHODS

This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence.

RESULTS

Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m².

CONCLUSION

Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain.

TRIAL REGISTRATION

The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).

"I'm not here to push you:" raising adolescents' treatment engagement via autonomy support

More than 45% of adolescents with aggressive behavior problems drop out of treatment prematurely. Building on insights from self-determination theory, we examined in three studies whether clinicians can raise adolescents' treatment engagement by supporting their autonomy. In an interview study (Study 1), clinicians (N = 16; 43.8% female; ages 30-57) spontaneously described 12 times more autonomy-supportive than controlling strategies to engage adolescents. In a preregistered experiment (Study 2), clinicians (N = 68; 88.2% female; ages 23-65) were confronted with videos of adolescents displaying resistance. We manipulated the DSM diagnosis of adolescents to indicate either aggressive behavior problems or other problems. We found that, regardless of diagnosis, clinicians used both autonomy-supportive strategies (57.7% of responses) and controlling strategies (39.3%), suggesting that applying autonomy support can be challenging with any adolescent displaying resistance. In an experimental study (Study 3), adolescents (N = 252; 50.0% female; ages 12-17) reported higher therapeutic alliance (d = 0.95, 95% CI [0.80, 1.10]) and treatment engagement (d = 0.77, 95% CI [0.63, 0.91]) after listening to audio-recorded autonomy-supportive versus controlling responses from clinicians, regardless of whether these adolescents had aggressive behavior problems. Overall, this research suggests that clinicians can raise adolescents' treatment engagement through autonomy support.

Psychotherapy readiness domains as predictors of psychotherapy outcome in trauma-affected refugees

INTRODUCTION

Little is known about predictors of psychotherapy outcome in trauma-affected refugees. Knowledge on outcome predictors can help clinicians identify patients prior to treatment who are not likely to benefit from standardized psychotherapy and take additional measures to adjust treatment to the individual patient. Given the dynamic nature of psychotherapy readiness domains, they represent potential targets to be worked with in therapy in order to improve outcomes.

METHODS

Psychotherapy readiness domains (locus of control, cognitive functioning, motivation for therapy, and personality functioning) were examined as potential predictors of psychotherapy outcome in trauma-affected refugees. Secondary analyses were conducted on data from a pragmatic randomized controlled trial. Study participants (N = 190) were refugees with PTSD who received flexible manual-based Cognitive Behavioral Therapy (CBT) at a psychiatric outpatient clinic in Denmark. Psychotherapy readiness domains were assessed via semi-structured interviews at the beginning of psychotherapy. Outcome variables were pre-post change in PTSD symptomology and global level of functioning.

RESULTS

Multiple regression analyses revealed that higher motivation for psychotherapy predicted improvement in PTSD symptomology and global level of functioning. Moreover, higher cognitive functioning predicted improvement in global level of functioning.

LIMITATIONS

The predictor rating scales need further psychometric evaluations in cross-cultural contexts.

CONCLUSIONS

These findings highlight the importance of considering motivation in psychotherapy offered to trauma-affected refugees. Further research is needed to identify potential barriers to motivation in this diverse patient population and to determine whether motivational interventions can lead to improved treatment outcomes.

Effects of the Multicomponent Cognitive Training Program BrainProtect in Cognitively Healthy Adults: A Randomized Controlled Trial

BACKGROUND

Cognitive integrity is a fundamental driver of health. The exact structure of strategies against cognitive impairment is still under debate.

OBJECTIVE

To compare the short-term effects of a multicomponent cognitive training (BrainProtect) with those of general health counseling (GHC) on cognitive abilities and health-related quality of life (HRQoL) in healthy adults in Germany.

METHODS

In this parallel randomized controlled trial (RCT), 132 eligible cognitively healthy adults (age ≥50 years, Beck Depression Inventory ≤9/63; Montreal Cognitive Assessment ≥26/30) were randomized to either GHC (N = 72) or to intervention with BrainProtect (intervention group, IG; N = 60). IG participants received 8 weekly sessions of 90 min of the group-based BrainProtect program focusing on executive functions, concentration, learning, perception, and imagination, plus nutritional and physical exercise units. Before and after intervention, all participants underwent neuropsychological testing and HRQoL evaluation, blinded for pretest.

RESULTS

No significant training effect was observed for the primary endpoint of global cognition as assessed by CERAD-Plus-z Total Score (p = 0.113; ηp2 = 0.023). Improvements in several cognitive subtests were shown in the IG (N = 53) compared to the GHC (N = 62) without adverse events. Differences reached significance for verbal fluency (p = 0.021), visual memory (p = 0.013), visuo-constructive functions (p = 0.034), and HRQoL (p = 0.009). Significance was lost after adjustment, though several changes were clinically relevant.

CONCLUSION

BrainProtect did not significantly impact global cognition in this RCT. Nevertheless, the results of some outcomes indicate clinically meaningful changes, so that a strengthening of the cognitive performance by BrainProtect cannot be excluded. Further studies with larger sample size are needed to confirm these findings.

Differences in Offending Behaviors, Aggression, Substance Use, and Mental Health Problems between Male Drug Dealers and Non-Drug Dealers in Belgian Youth Detention Centers

This study investigated whether drug dealing juvenile offenders in Belgium differ from non-drug dealers in levels of violent and non-violent offending behaviors, aggression, substance use, and mental health needs. The current study examined data from 226 16- to 17-year-old male juvenile offenders. Information relating to drug dealing, substance use, and mental health needs were collected through self-report questionnaires. A structured diagnostic interview was used to collect information about past violent and non-violent behaviors. Chi-square tests and multivariate analysis of variance compared non-dealers and dealers and explored if hard-drug dealers and soft-drug dealers differed from each other. Relative to non-drug dealers, drug dealers engaged in more violent offending behaviors, exhibited higher levels of aggression, substance use and oppositional defiant problems, and displayed lower levels of anxiety. Soft- and hard-drug dealers did not differ from each other. To conclude, detained drug dealers are characterized by severe antisocial behavior.

Prospective associations between working alliance, basic psychological need satisfaction, and coaching outcome indicators: a two-wave survey study among 181 Dutch coaching clients

BACKGROUND

The coach-coachee working alliance and coachee motivation seem important factors for achieving positive coaching results. Self-determination theory, specifically basic psychological need theory, has been proposed as a relevant framework for understanding these relationships. The current longitudinal survey study therefore investigates prospective associations between coachees' appraisal of the working alliance, basic psychological need satisfaction, and the coaching outcome indicators goal attainment, wellbeing, absence of psychopathology, and personal growth initiative.

METHODS

The sample (N = 181) consisted of Dutch coachees that were recruited across a range of coaching settings and contexts. Online self-report questionnaires were administered twice (T0 and T1), with an intervening time of 3 weeks, assessing working alliance, basic psychological need satisfaction, goal attainment, wellbeing, absence of psychopathology, and personal growth initiative. Parallel analysis with Monte Carlo simulations and confirmatory factor analyses were performed to assess the dimensionality of working alliance and basic psychological need satisfaction scores. Multiple regression analyses (stepwise) were used to examine prospective (T0 to T1) associations between working alliance and basic psychological need satisfaction, and their association with outcome indicators.

RESULTS

The coachees' perception of the working alliance was positively and reciprocally, although modestly, associated with basic psychological need satisfaction. In addition, both working alliance and basic psychological need satisfaction were prospectively associated with goal attainment, but not with other outcome indicators.

CONCLUSIONS

Results provide tentative support for a role of basic psychological need satisfaction in facilitating the establishment of a good working alliance. Additionally, the perception of a good quality, need supportive relationship with the coach appears to be associated with better goal achievement, but not with other outcome indicators. Associations were generally modest, and more research is needed to better measure and comprehend the unique contributions of specific relational and motivational factors to outcomes in coaching and assess the robustness of the current study findings.

Factors associated with symptom severity in Canadian youth with mental health and/or addictions concerns accessing service navigation

This study investigated the factors associated with clinical symptoms and level of functioning at baseline and after 4 months of navigation, in youth with mental health and/or addiction concerns involved with a family navigation service. Participants in this pre-post study were caregivers who accessed a mental health and addictions navigation service between March 2018 and July 2019 on behalf of their youth aged 13-26 who had mental health and/or addiction concerns. Evaluations were conducted at baseline and at 4 months after entering navigation. The dependent variable, youth mental health symptoms and functioning, was assessed by caregivers using the Symptoms and Functioning Severity Scale. The sample included 345 caregivers of youth (youth: mean age 18 years, 57% male). At intake, using multiple linear regression, caregiver strain (β = 0.481, p < 0.001), youth completion of ADLs (β = -0.156, p = 0.002) and youth motivation (β = -0.110, p = 0.021) contributed significantly to variance in symptoms and functioning (R²  = 0.373, p < 0.001). Using ANOVA to compare complete pre/post data (n = 115), there was a significant main effect of time on the youth symptoms and functioning score (F[1, 107] = 9.278, p = 0.003). Furthermore, the interaction of time, youth completion of ADLs (low vs. high at baseline) and youth motivation (low vs. high at baseline) was significant (F[1, 107] = 4.699, p = 0.032). Youth with low motivation and low completion of ADLs at baseline experienced the largest improvements in symptoms and functioning after 4 months of navigation. These findings suggest that this group of youth should be a primary target in mental health and addiction navigation.

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review

BACKGROUND

Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions.

AIMS

This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists.

METHODS

A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved.

RESULTS

The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed.

CONCLUSION

It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.

Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder

PURPOSE

Self-determination theory suggests that autonomous motivation for change (i.e., motivation that is internal and self-endorsed) can be enhanced in therapeutic contexts by clinicians acting in an autonomy supportive manner. While previous research has established a link between autonomy support (AS) and autonomous motivation in enhancing outcomes in eating disorder (ED) treatment, few studies have examined factors that support or hinder therapists' ability to be autonomy supportive in the context of an ED therapeutic encounter. The goal of the present study was to conduct a qualitative analysis of personal and contextual factors that facilitated or hindered therapists' ability to provide autonomy supportive interventions.

METHODS

Semi-structured interviews were conducted with 10 therapists conducting outpatient psychotherapy at a specialized eating disorders treatment program. Data were analyzed using thematic analysis.

RESULTS

The most frequently noted facilitators were organizational support of AS interventions and patients' engagement and motivation for treatment. The most frequently noted barriers were patients' personality variables such as patients that exhibit passive and help-rejecting behaviours, as well as therapists feeling overwhelmed due to a high workload.

CONCLUSION

Our results provide insight into the factors that facilitate and impede the utilization of an autonomy supportive approach in specialized ED treatment and can be used to inform future quantitative research on such factors.

LEVEL OF EVIDENCE

Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Reducing missed psychotherapy appointments: An advanced practice nurse-initiated telephone orientation protocol

PURPOSE

Missed appointments pose significant challenges to the health care system as they contribute to the inefficient use of resources, increase costs, and result in poor outcomes. The aim of this project was to reduce the rate of missed adult psychotherapy appointments by implementing a Psychiatric-Mental Health Nurse Practitioner-initiated telephone orientation protocol (TOP).

DESIGN

Quasi-experimental.

METHODS

The TOP intervention combined an attendance policy review, psychoeducation, and motivational interviewing techniques. Missed appointment rates were compared before and after initiation of the TOP.

FINDINGS

The TOP significantly reduced the rates of missed appointments by 55% over 12 weeks.

PRACTICE IMPLICATIONS

The TOP can be implemented as standard care to increase client engagement, improve appointment attendance, and boost clinician productivity.

The Effect of Autonomy and Self-Control on Changes in Healthy Lifestyles of Inactive College Students through Regular Exercise

This study aimed to verify the influence of autonomy and self-control as psychological factors on the changes in lifestyles of inactive college students by participating in regular exercise. A total of 188 university students in Seoul, Korea, taking physical fitness classes for 5 weeks held three times a week participated in the surveys. Surveys were conducted in the first session (T1) and 15th session (T2) of the classes. Autonomy in exercise participation and self-control were measured at T1, and healthy lifestyle was measured at both T1 and T2. A paired t-test was used to measure the changes in healthy lifestyle between two time points, and hierarchical regression analysis was conducted to determine the effect of autonomy in exercise participation and self-control measured at T1 on the healthy lifestyle score at T2. According to the analysis, participants' healthy lifestyles were improved with a statistically significant difference between pre- and post-exercise. Furthermore, the levels of autonomy and self-control before the fitness classes positively influenced the participants' healthy lifestyle after the classes even when the influence of healthy lifestyle measured before the classes was controlled. Thus, it was confirmed that autonomy for participation and self-control are important to change one's healthy lifestyle through regular exercise participation.

Personal and contextual determinants of COVID-19 vaccination intention: a vignette study

BACKGROUND

This vignette study explores which factors contribute to higher COVID-19 vaccination intentions.

METHODS

Between the 4^th-11 January 2021, we recruited 15,901 Belgian citizens (M_age = 50.11 years, range 18-100) through convenience sampling to participate in a vignette study. In each vignette, we manipulated contextual determinants consisting of different factors. Each participant rated six vignettes in terms of the outcomes 'vaccination intention' and 'recommendation to others.' Finally, we explored the benefits of tailored communication by examining whether these ratings depended upon citizens' initial motives for vaccination.

RESULTS

Participants are most likely to accept a vaccine when they expect no or only small side effects, when the vaccine offers a 95% protection, and when people can no longer infect others (p < 0.001). The possibility to receive the vaccine at home or at the GP's office, highlighting that most citizens are willing to get vaccinated, and emphasizing the protective benefits for others yielded additional positive effects (p < 0.001). Results showed that tailored communication has a small but significant effect, especially for individuals high on distrust-based amotivation (p < 0.01).

CONCLUSION

In addition to vaccine characteristics, there is room for policymakers to respond to those determinants that fall under their control and can thus be highlighted within communication campaigns.

An interventional study with the Maldives generalist teachers in primary school physical education: An application of self-determination theory

In Maldives’ primary schools, physical education (PE) is mainly taught by generalist classroom teachers who often lack knowledge and confidence to teach PE. Also, PE programs in primary schools are affected by a perceived lack of infrastructure, resources and equipment. Children in primary schools are allocated one 35 minute period of PE per week. Researchers have previously investigated interventions implemented by specialist PE teachers to enhance the motivation of secondary school students in PE classes. However, limited research has been conducted with generalist teachers’ implementing PE intervention with primary school children. In this study we applied self-determination theory to investigate the effects of a professional learning program and an associated resource support package, that was then delivered by the Maldives generalist teachers’ delivering PE. The participants were 30 primary school teachers (control group, n = 15; intervention group, n = 15), and their 725 primary school students aged 9–12 years (mean age of 10.5 years). The teachers in the group undertook eight hours of professional learning that focused on strategies and behaviours to support student satisfaction for the three main elements of self-determination theory: autonomy, competence, and relatedness. A repeated measure ANCOVA was carried out for each of the dependent variables. Overall results when compared to pre-intervention measures, the students of teachers in the intervention group significantly increased their post-intervention perceptions for autonomy, competence, and relatedness; and, increased their psychological need satisfaction. Moreover, intervention-students in the post-intervention phase reported reduced need frustration for autonomy, competence, and relatedness; and, experienced higher levels of self-efficacy, enjoyment and engagement. We contend that these results accentuate the usefulness of professional learning programs for generalist teachers delivering PE to promote students’ psychological need satisfaction, whilst reducing thwarting behaviours to enhance students’ self-determined motivation toward PE classes. The intervention program significantly enhanced the students’ perceived need support, and autonomous motivation, it also reduced teachers’ need frustrating behaviours within PE classes. Facilitating teachers to provide more moderate to vigorous physical activity (MVPA) and psychological need support could reduce the rate of non-communicable diseases that are currently prevalent in the Maldives.

The Effects of Contextual Factors, Self-Efficacy and Motivation on Learners' Adaptability to Blended Learning in College English: A Structural Equation Modeling Approach

Objective

Few research efforts have substantially introduced relevant studies on Chinese students' adaptability in relation to the ineffectiveness of blended learning mode in College English. This study is guided by social cognitive theory, and related literature has been reviewed concerning adaptability. In this study, we aim to examine the involved relationships among contextual factors, self-efficacy, motivation, and adaptability to blended learning mode among non-English majored Chinese learners in the College English course.

Methods

The quantitative research method was employed in this study, and 595 respondents were eventually collected to enable the data analysis. The structural equation modeling (SEM) approach was used to analyze the data.

Results

(1) The non-English majored learners' adaptability to blended learning mode in College English was at a low level with a mean value of 2.26, indicating that students still suffer difficulties from class conducted in blended learning; (2) the fit indices were at the level of good fit, and it suggested the structural model had an overall good fit to the data as shown: x 2/df = 2.496, RMESA = 0.050, GFI = 0.956, AGFI = 0.936, NFI = 0.968, RFI = 0.959, IFI = 0.980, TLI = 0.975, CFI = 0.980; (3) adaptability was positively related to contextual factors, self-efficacy, and motivation (p < 0.001); (4) contextual factors exerted an indirect effect on the adaptability not only through the separate mediating role of self-efficacy and motivation, but through the chain mediating role of self-efficacy and motivation (p < 0.01).

Implications

This study theoretically extends previous studies on adaptability by investigating the affecting factors in the framework of social cognitive theory. More practically important is that this study sheds light on the impact mechanism of positive and enjoyable environment, self-efficacy and motivation on non-English majored learners' adaptability to blended learning mode in English course, which would provide a vital insight for administrators and College English instructors to reconsider the role of learners' responses in the mixed mode to improve their English achievement more effectively, as well as to enhance and promote their user experience of the offered blended learning service.

The mediating role of prosocial motivation in the context of knowledge sharing and self-determination theory

Purpose

This paper aims to determine whether prosocial motivation acts as a mediator between the individual motivation types of self-determination theory and knowledge sharing.

Design/methodology/approach

A partial least squares structural equation model (PLS-SEM) based on data collection (N = 303) ) was calculated, using “Smart PLS 3” software.

Findings

In respect of the influence of individual motivation types on knowledge sharing, it was found that prosocial motivation provides indirect mediation for external motivation and complementary mediation for introjected motivation, whereas it has no mediation effect on intrinsic and identified motivation.

Research limitations/implications

Future research should consider the use of prosocial motivation as a mediator to reveal indirect effects that, otherwise, are at risk of remaining hidden.

Practical implications

To foster knowledge sharing within organizations, measures should be taken to increase external, introjected and prosocial motivation, as it was found that these types of motivation have a significant positive impact on knowledge sharing.

Originality/value

The current unanswered question – whether or not prosocial motivation acts as a mediator between the motivation types of self-determination theory and knowledge sharing – is examined, thereby providing insights into the hitherto largely unexplored role of prosocial motivation in knowledge-sharing models.

How supervisors can support employees' needs and motivation? an experimental study based on SDT

Supervisors and managers have an increasingly significant role in employees' motivation. The applied framework in this field research was the Self-Determination Theory (SDT). In this way, it was assessed that whether supervisors can be trained in order to support employees' basic psychological needs including autonomy, relatedness, and competence. As a result, their need satisfaction and autonomous motivation were promoted, at the same time, the controlled motivation and amotivation were reduced. The training was provided to 15 supervisors then employees' need satisfaction, amotivation, controlled motivation, and autonomous motivation were investigated, pre- and post-intrvention. Performing a multilevel regression analysis revealed that employees in the intervention group showed an increment in autonomous motivation and need satisfaction, as well as a significant reduction in amotivation than those of the control group. Furthermore, increasing autonomous motivation and decreasing amotivation were moderated via increasing need satisfaction. An added value has been provided for the mentioned theory on need satisfaction by the current study. It was also indicated that a relatively brief intervention for supervisors may affect creating employees need support, and autonomous motivation increment, and amotivation reduction.

Effect of Technology-Assisted Brief Abstinence Game on Long-term Smoking Cessation in Individuals Not Yet Ready to Quit: A Randomized Clinical Trial

IMPORTANCE

Most trials of behavioral or pharmaceutical interventions for people who smoke are limited to individuals reporting they are ready to quit smoking. Engaging individuals who initially report they are not yet ready to quit in brief, precessation, skills-building interventions (eg, practice quit attempts or nicotine replacement therapy [NRT] sampling) is challenging.

OBJECTIVE

To test an integrated behavioral plus NRT-sampling intervention using a gamification approach supported by mobile health.

DESIGN, SETTING, AND PARTICIPANTS

A multisite randomized clinical trial with site-level 1-to-1 allocation into 2 conditions was conducted in 4 US health care systems. A total of 433 individuals who were currently smoking and reported at enrollment that they were not ready to quit smoking were enrolled. The study was conducted from November 7, 2016, to July 31, 2020.

INTERVENTIONS

Take a Break (TAB) was a 3-week game experience and included 5 behavioral components (motivational messaging, challenge quizzes, brief abstinence goal setting, mobile health apps for cravings management, and reward points for participation) integrated with NRT sampling. TAB draws on social cognitive theory and game mechanics concepts to engage participants in health behavior change. The comparison included NRT sampling only.

MAIN OUTCOMES AND MEASURES

Time to first quit attempt (duration from TAB experience to primary outcome) and carbon monoxide level-verified smoking cessation at 6-month follow-up. All analyses used an intention-to-treat approach.

RESULTS

Of the 433 individuals included in the trial, 223 were women (52%); mean (SD) age was 54 (13) years. More than half (53% [112 of 213]) of the TAB participants completed 100% of the daily challenge quizzes in the first week, 73% (145 of 199) of participants who completed the goal-setting call set a brief abstinence goal (most frequently 1-2 days of abstinence from cigarettes), and 75% (159 of 213) of participants used the mobile health apps to manage nicotine cravings. Time to the first quit attempt was lower for the TAB vs comparison group (hazard ratio, 1.68; 95% CI, 1.09-2.60; P = .02). At the 6-month follow-up, 18% (28 of 160) of TAB participants and 10% (17 of 171) of the comparison (χ2 test, P = .045) participants obtained carbon monoxide level-verified smoking cessation (accounting for clustering of outcomes by site; odds ratio, 1.92; 95% CI, 1.01-3.68; P = .048).

CONCLUSIONS AND RELEVANCE

The findings of this randomized clinical trial demonstrate that individuals not yet ready to quit smoking could be engaged in a brief abstinence game. Six months later, the TAB group had nearly double the rate of smoking cessation vs the NRT sampling comparison group. Integrating a skills-building game experience with brief NRT sampling can enhance long-term cessation among those not yet ready to quit smoking.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02973425.

Knowledge, attitude and practices of lifestyle modification and associated factors among hypertensive patients on-treatment follow up at Yekatit 12 General Hospital in the largest city of East Africa: A prospective cross-sectional study

BACKGROUND

Hypertension is a devastating global public health challenge; studies indicated that Ethiopia has been affected by the burden of hypertension especially in urban areas. The overall prevalence of hypertension in Ethiopia was estimated to be 19.6% (23.5% in urban and 14.7% in rural population). Along with medical management of hypertension, appropriate lifestyle modification is a crucial and inexpensive means of hypertension control. The main purpose of the study was therefore to assess knowledge, attitude and practice of lifestyle modification among patients on follow up for hypertension treatment at Yekatit 12 General Hospital.

METHODS

A prospective cross-sectional study design was applied in Yekatit 12 General Hospital from October 28, 2018, to February 28, 2019, by allotting proportionate samples from the two chronic outpatients departments (OPD). Using single proportion sampling techniques, the study participants were selected and the total sample size calculated was 405. Primarily, clinical measurements were made according to the international standard set to verify true hypertensive patient's inclusions. Then, data about socio-demographic characteristics, lifestyle modification related to knowledge, attitude and practices were comprehensively collected using an interviewer-administered structured questionnaire. The collected data was entered into Epi-data exported to SPSS Window version of 22 for analysis. All variables with ρ-value less than 0.05 in the final model were considered as independently associated with knowledge, attitude and practices of patients' lifestyle modification. The strength of association was described by Odds Ratio (OR) at the corresponding CI of 95%.

RESULTS

The overall sampled hypertensive patients as compared to the planned sample size was 95.5% (n = 387), out of which 53.5% (n = 207) was male patients. The mean age was 50 years with a standard deviation of 14.4. The study revealed that 67.7% [95% CI (65.32%, 70.08%)] were knowledgeable; and 54.0% [95% CI (51.34%, 56.6%)] were reported to have favorable attitude towards lifestyle modification. Regarding their practices, 38% [95% CI (19.91%, 57.49%] of the respondents had good practices. Their monthly income [AOR = 2.39, 95% CI (1.12, 5.11)] and duration on-treatment follow up since diagnosed with hypertension [AOR = 4.39, 95% CI (1.20, 16.03)] were independently associated with knowledge. Concerning their damned practices, age [AOR = 7.71, 95% CI (2.4, 24.8)] and knowledge [AOR = 3.94, 95% CI (2.01, 7.72)] were independently associated with the practices.

CONCLUSION

Though the encouraging high knowledge status and favourable attitudes towards lifestyle modification among hypertensive patients, the practices are among the lowest findings report in all standards. Hence, older patients, jobless patients, and low-income patients and patients on long-term treatment follow up who were diagnosed with hypertension before 10 years needs special attention and interventions by the country NCDs policy formulators to rise their non-pharmacological practices to control high blood pressure and its consequences.

Nurses' perceptions of factors influencing treatment engagement among patients with cardiovascular diseases: a systematic review

Background

Nurses are key to the success of patient engagement, yet we know little about nurses’ perceptions on treatment engagement and how they can contribute to treatment engagement. Qualitative evidence to identify factors that influence treatment engagement among patients with CVD from nurse’s perspective is limited.

Methods

This systematic review of qualitative research was based on the PRISMA reporting guidelines. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess quality by two reviewers independently. Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase- Non-Medline, Scopus, and the Cochrane Library, were systematically searched from 2001 to 2020. The search strategy included keywords and MeSH terms to identify relevant studies written in English.

Results

Eight articles were included in the review. Four key themes were synthesised from the findings: nurses need training and up to date information, providing support for patients, patient motivation to engage with treatment plans and perceived lack of time.

Conclusion

Nurses described the importance of training to help them support patients to engage as effectively as possible and their role in providing social and psychological support. They also described the importance of patient motivation to engage in a treatment and plan and sustain engagement and time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00765-2.

Autonomous Motivation and Self-Disclosure Intention

Studies that specifically discuss the formation of autonomous motivations of users of social networking services (SNSs) and how such motivation influences SNS user intention to disclose personal location-related information (PLRI) are absent from the literature. Consequently, this study, based on the self-determination theory and the information system success (ISS) model, investigates the relationships among key system-related quality factors, SNS users’ autonomous motivations and user satisfaction regarding an SNS, and their intentions to disclose PLRI. Survey data collected from 514 students at six universities were analyzed to validate our research model. Research results show that three system-related quality factors have different influences on user satisfaction and autonomous motivation, while both autonomous motivation and user satisfaction are significant antecedents of user intention to disclose PLRI. The research results have extended the application and advanced the understanding of ISS model and self-determination theory in the context of SNS.

Dreaming of effective diet change? Motivation, emotions, and dietician presence can all matter

The objective of this study is to verify the relevance of motivational and emotional factors, as well as dietician presence in relation to the optimization of the dietary pattern-change process. This study was carried out with an on-line survey, including 341 respondents, almost half of whom were consulted by a dietician. Two measures were applied to evaluate the effectiveness of the dietary pattern-change among participants. The first of these measures refers to subjective evaluations of diet improvement, while the second refers to weight loss. The results show that autonomous motivation and dietician presence are associated with positive anticipatory emotions, and diet improvements. Extrinsic regulation, dietician presence, and lack of negative emotional experiences are related to greater weight loss.

Technology can`t replace people, but it is a helpful tool: A qualitative study on patients’ experiences of using a smartphone-application post-cardiac rehabilitation (Preprint)

Background

Exercise-based cardiac rehabilitation (CR) is a crucial part of the treatment of patients with cardiac diseases, and adherence to healthy behavior is a prerequisite to improve long-term prognosis. Unfortunately, adherence to healthy behavior adapted in CR is challenging for many cardiac patients in the long term. Recently, we demonstrated that follow-up conducted via an app for 1 year significantly improved adherence to healthy behavior after CR. To increase the knowledge and understanding of mobile Health (mHealth) interventions that can promote acceptance and adherence, qualitative research investigating patients’ experiences with these interventions is warranted.

Objective

The aim was to investigate patient experiences with individualized long-term follow-up conducted via an app for 1 year and their thoughts about what features promoted adherence to healthy behavior after CR. The purpose was to increase the understanding of significant findings previously reported and to guide future development of similar interventions in the field of adherence.

Methods

A qualitative study with individual interviews was conducted from November 2018 to May 2019. A thematic interview guide was used when conducting the semistructured in-depth interviews. The interviews were audio recorded and transcribed successively during the period in which the interviews were conducted. Texts were managed and systematized by NVivo. Interviews were analyzed by qualitative content analysis. Codes and themes were inductively developed.

Results

Ten patients who had participated in a randomized controlled trial evaluating the effect of follow-up conducted via an app on adherence to healthy behavior after CR were included. The median patient age was 65 years (range 46-72 years), and both genders were represented. The analysis resulted in the following 4 themes describing the patients’ experiences: (1) The person behind the app is crucial for motivation and adherence; (2) The app as a commitment; (3) The app as a path to independence; and (4) Suggestions for improvements. Features experienced as beneficial to promote adherence were individualized feedback and the use of goal setting. The significance of the person behind the app (the supervisor) who provided individualized feedback was a consistent finding. This person seemed to promote motivation in general and to enable other known behavioral change techniques.

Conclusions

The person behind the app (the supervisor) seems to be one of the most significant success factors in promoting adherence to healthy behavior after CR. This indicates that a health care provider must actively participate in a patient’s process of adherence to healthy behavior, even when using interventions, including an app. Future development of interventions in the field of adherence should strive to create tools that enable an ongoing collaborative relationship between the patient and the health care provider. The follow-up should be based on the patient’s own goals, and individualized feedback should be provided.

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

To address the need for conceptual and clinical consensus within the field, psychotherapy research has increasingly focused on identifying common principles of change. While the field contends that this approach is atheoretical, we argue that principles of change cannot be fully understood or applied without the context of some theoretical framework. This article develops such a framework by identifying and explicating two theoretical assumptions that are implicitly shared by multiple therapeutic approaches: (1) that increasing agency is a fundamental aim of psychotherapy, and (2) that therapists enhance clients' agency by increasing their awareness. Building on the largely disparate empirical literatures demonstrating the importance of client agency and awareness to successful therapeutic outcomes, we provide a theoretical account of the highly iterative and synergistic meta-process by which these two factors jointly produce change. Explicit identification and empirical investigation of this Agency via Awareness psychotherapy meta-process, we argue, could facilitate scientific and clinical progress within the field. The hypothesized meta-process is discussed in relation to existing integrative models of therapeutic change, and its manifestations in the theory and practice of major therapeutic orientations are reviewed and illustrated. We discuss how this framework can facilitate psychotherapy research by providing a common language and conceptual foundation for wide-ranging therapeutic approaches, constructs, and findings. Finally, by raising clinicians' awareness of the implicit assumptions underlying their therapeutic work, we suggest that the Agency via Awareness framework can increase their agency over when and how they apply these assumptions in therapy to maximize client improvement.

Chinese stroke survivors' perceptions of participation in exercise or sitting Tai Chi

AIMS

Exercise promotes functional recovery among stroke survivors and is recommended to be commenced as soon as is feasible. However, little is known about stroke survivors' perception of participation in exercise or sitting Tai Chi, a more culturally appropriate and popular movement in China. To explore Chinese stroke survivors' perceptions of participation in exercise or sitting Tai Chi.

METHODS AND RESULTS

Face-to-face semi-structured interviews and content analysis of transcripts were conducted with a purposive sample of 30 stroke survivors. The qualitative study explored perceptions of post-stroke participation in exercise or sitting Tai Chi. The consolidated criteria for reporting qualitative research checklist was used to report findings. Perceived facilitators of exercise participation were healthcare professionals' encouragement and recommendations, family and peer support and survivors' motivation, intention, and self-perceived benefits. Perceived barriers were fear of falling, physical discomfort, and challenges in standing. Despite some reservations, most participants were willing to try sitting Tai Chi.

CONCLUSIONS

Encouragement and support, motivation, and perceived benefits were important for exercise participation after stroke. With the premise that all medical and nursing students in China are trained in Tai Chi, for stroke survivors with no access to formal exercise programmes, sitting Tai Chi may offer an appropriate alternative.

The Motivation Journey: A Grounded Theory Study on Female Cancer Survivors' Experience of a Psychological Intervention for Quality of Life

Psychological interventions are proposed to cancer survivors to support their quality of life against the emotional trauma of cancer and the side effects of treatment. Psychological interventions often require patient engagement and commitment to activities that could be more or less demanding in terms of lifestyle change (e.g., psychotherapy, sports). Analyzing participant motivations (personal aims, expectations, needs) prior to participation is useful to predict their adherence to the intervention as well as final outcomes. Yet, participant motivations may evolve during the intervention because the intervention experience turns out to be meaningful and positively challenging. The present study aimed to obtain a preliminary understanding of the process of motivation change in female cancer survivors who participated in a sport-based intervention to promote quality of life by employing a grounded theory approach. Data analysis took place alongside data collection and according to the procedure of grounded theory ("open coding", "axial coding", and "selective coding") in order to describe the process of motivation change during women's participation in psychological intervention for quality of life. On 14 women interviewed, 13 reported changing their motivation to participate during the first months of involvement, mostly changing from individualistic to group-related motivations (i.e., from self-care to friendship with other participants and enriching group membership), and from physical to psychological growth (i.e., pursuing not only physical health but also self-fulfillment). The discussion explains the preliminary aspects of the motivation change process and highlights the importance to monitor motivation dynamics within psychological interventions.

Does motivation predict return to work? A longitudinal analysis

OBJECTIVES

Motivation for return to work (RTW) reflects the degree of willingness to resume work activities and has been shown to be a crucial factor in long-term work disability. The satisfaction of basic psychological needs and motivation as described by the Self-Determination Theory (SDT) yield associations with outcomes such as quality of life and job satisfaction. The current study is the first study to examine whether motivation and basic psychological needs are predictive for RTW outcomes at 1-year follow-up.

METHODS

About 349 people with a work disability (mean = 131.32 days off work) participated in this observational longitudinal research. Quality of motivation (MAWS) and basic psychological need satisfaction and frustration (BPNSFS) were measured at baseline. At 12-month follow-up, differences in RTW were assessed in terms of (1) time until RTW, (2) partial RTW, (3) relapse within 12 months, (4) work disability longer than 12 months. Binary logistic and cox regression analyses were used.

RESULTS

Controlled motivation regarding the former job was related to shorter time until RTW. Autonomous motivation and amotivation did not seem predictive for RTW variables. The frustration of the basic needs was related to a longer work disability, need satisfaction was not related to the RTW variables. No significant predictors for relapse and partial RTW were found.

CONCLUSIONS

The frustration of basic psychological needs was predictive for a longer work disability. Controlled motivation on the other hand predicted faster RTW, which was an unexpected direction. SDT seems to have predictive value, yet underlying mechanisms remain unclear.

Autonomous Motivation Moderates the Relation of Self-Criticism to Depressive Symptoms Over One Year: A Longitudinal Study of Cognitive-Behavioral Therapy Patients in a Naturalistic Setting

Introduction: This study examined whether motivation moderated the relation between self-criticism and depression over one year in a sample of adults receiving cognitive-behavior therapy (CBT).

Methods: Participants (N = 38) completed measures of pre-treatment self-criticism (Time 1), autonomous/controlled motivation for engaging in CBT at the beginning of treatment (Time 2), and interviewer-rated depression at Time 1, and one year after baseline (Time 3).

Results: Multiple regression analyses of moderator effects showed that patients higher in self-criticism with lower autonomous motivation for CBT had higher levels of depressive symptoms one year later. The effect of controlled motivation was nonsignificant.

Discussion: Our findings support the buffering hypothesis that engaging in CBT because it is personally meaningful may protect patients high in self-criticism from experiencing the poorer treatment outcomes associated with their specific vulnerability. However, given the small sample size, the results will need to be replicated within larger samples to ensure generalizability.

Improving Diabetes Management in Emerging Adulthood: An Intervention Development Study Using the Multiphase Optimization Strategy

Background

Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions leveraging emerging adults’ innate developmental need for autonomy may offer a route to improving diabetes outcomes by increasing feelings of responsibility for and control over diabetes self-management activities.

Objective

This research project will use the multiphase optimization strategy to test the efficacy of three autonomy-supportive intervention components to elicit a clinically significant improvement in metabolic control, assessed by a 0.5% improvement in hemoglobin A_1c (HbA_1c), among older adolescents and emerging adults (16-25 years) with poorly controlled type 1 diabetes (T1D; HbA_1c≥9.0%).

Methods

A question prompt list (QPL) is a tool to empower patients to assume a more active role during medical visits by asking questions and stating concerns. The motivation enhancement system (MES) is a brief counseling intervention that uses motivational interviewing communication strategies to build intrinsic motivation and self-efficacy for self-management. Text message reminders to complete diabetes care tasks may increase self-efficacy for diabetes self-management. After refining these intervention components for emerging adults, we will conduct a component selection experiment using an eight-arm full factorial design: 2 (QPL yes or no)×2 (MES yes or no)×2 (Text yes or no). Participants will complete 3 study visits: baseline, treatment end at 2 months, and a follow-up at 6 months. The primary outcome is metabolic control, which will be measured via HbA_1c. Secondary outcomes include diabetes management and diabetes clinic attendance. SDT constructs of intrinsic motivation, self-efficacy, and the quality of the patient-provider relationship (ie, relatedness) are hypothesized mediators. Depression symptoms and emerging adults’ gender are hypothesized moderators. We will use the mixed-effects linear model for the analysis of variance of a factorial design to analyze continuous longitudinal experimental data; the generalized linear model will be used with categorical outcomes (eg, treatment attendance). The experiment was powered to detect the main effects of the intervention on the primary outcome.

Results

A total of 20 participants have enrolled and completed a qualitative interview after reviewing one or more intervention components. Analysis of interview data are underway, with a report of these results anticipated in the fall of 2020. The clinical trial will be launched in the fall 2020, with participants enrolled through May 2023 and data collection continuing through November 2023.

Conclusions

At the end of this experiment, we will have empirical evidence to support a large-scale, multisite effectiveness trial of an intervention package that has been optimized for older adolescents and emerging adults with poorly controlled T1D.

Trial Registration

ClinicalTrials.gov NCT04066959; https://clinicaltrials.gov/ct2/show/NCT04066959

International Registered Report Identifier (IRRID)

DERR1-10.2196/20191

Family group decision-making for children at risk of abuse or neglect: A systematic review

Background

Capturing the scale of child maltreatment is difficult, but few would argue that it is anything less than a global problem which can affect victims' health and well-being throughout their life. Systems of detection, investigation and intervention for maltreated children are the subject of continued review and debate.

Objectives

To assess the effectiveness of the formal use of family group decision-making (FGDM) in terms of child safety, permanence (of child's living situation), child and family well-being, and client satisfaction with the decision-making process.

Search Methods

Both published and unpublished manuscripts were considered eligible for this review. Library staff from Scholarly Information (Brownless Biomedical Library) University of Melbourne, conducted 14 systematic bibliographic searches. Reviewers also checked the reference lists of all relevant articles obtained, and reference lists from previously published reviews. Researchers also hand-searched 10 relevant journals.

Selection Criteria

Study samples of children and young people, aged 0-18 years, who have been the subject of a child maltreatment investigation, were eligible for this review. Studies had to have used random assignment to create treatment and control groups; or, parallel cohorts in which groups were assessed at the same point in time. Any form of FGDM, used in the course of a child maltreatment investigation or service, was considered an eligible intervention if it involved: a concerted effort to convene family, extended family, and community members; and professionals; and involved a planned meeting with the intention of working collaboratively to develop a plan for the safety well-being of children; with a focus on family-centred decision-making.

Data Collection and Analysis

Two review authors independently extracted the necessary data from each study report, using the software application Covidence. Covidence highlighted discrepancies between data extracted by separate reviewers, further analysis was conducted until a consensus was reached on what data were to be included in the review. Two authors also independently conducted analyses of study bias.

Main Results

Eighteen eligible study reports were found, providing findings from 15 studies, involving 18 study samples. Four were randomised controlled trials (RCTs; N = 941) the remainder employed quasi-experimental designs with parallel cohorts. Three of the quasi-experimental studies used prospective evaluations of nonrandomly assigned comparison groups (N = 4,368); the rest analysed pre-existing survey data, child protection case files or court data (N = 91,786). The total number of children studied was 97,095. The longest postintervention follow-up period was 3 years. Only four studies were conducted outside the United States; two in Canada and one in Sweden and one in the Netherlands. The review authors judged there to be a moderate or high risk of bias, in most of the bias categories considered. Only one study referenced a study protocol. Eleven of the fifteen studies were found to have a high likelihood of selection bias (73%). Baseline imbalance bias was deemed to be unlikely in just two studies, and highly likely in nine (60%). Confounding variables were judged to be highly likely in four studies (27%), and contamination bias was judged highly likely in five studies (33%). Researcher allegiance was rated as a high risk in three studies (20%) where the authors argued for the benefits of FGDM within the article, but without supporting references to an appropriate evidence base. Bias from differential diagnostic activity, and funding source bias, were less evident across the evidence reviewed. This review combines findings for eight FGDM outcome measures. Findings from RCTs were available for four outcomes, but none of these, combined in meta-analysis or otherwise, were statistically significant. Combining findings from the quasi-experimental studies provided one statistically significant finding, for the reunification of families, favouring FGDM. Ten effect sizes, from nine quasi-experimental studies, were synthesised to examine effects on the reunification of children with their family or the effect on maintaining in-home care; in short, the effect FGDM has on keeping families together. There was a high level of heterogeneity between the studies (I 2 = 92%). The overall effect, based on the combination of these studies was positive, small, but statistically significant: odds ratio (OR), 1.69 (confidence interval [CI], 1.03, 2.78). Holinshead's (2017) RCT also measured the maintenance on in-home care and reported a similar result: OR, 1.54 (CI, -0.19, 0.66) not statistically significant. The overall effect for continued maltreatment from meta-analysis of five quasi-experimental studies, favoured the FGDM group, but was not statistically significant: OR, 0.73 (CI, 0.48, 1.11). The overall combined effect for continued maltreatment, reported in RCTs, favoured the control group. But it was not statistically significant: OR, 1.29 (CI, 0.85, 1.98). Five effect sizes, from nonrandomised studies, were synthesised to examine the effect of FGDM on the number of kinship placements. The overall positive effect based on the combination of these studies was negligible: OR, 1.31 (CI, 0.94, 1.82). Meta-analysis was not possible with other outcomes. FGDM's role in expediting case processing and case closures was investigated in six studies, three of which reported findings favouring FGDM, and three which favoured the comparison group. Children's placement stability was reported in two studies: an RCT's findings favoured the control, while a quasi-experimental study's findings favoured FGDM. Three studies reported findings for service user satisfaction: one had only 30 participants, one reported a statistically significant positive effect for FGDM, the other found no difference between FGDM and a control. Engagement with support services was reported in two studies; neither reported statistically significant findings.

Authors' Conclusions

The current evidence base, in this field, is insufficient to draw conclusions about the effectiveness of FGDM. These models of child protection decision-making may help bring about better outcomes for children at risk, or they may increase the risk of further maltreatment. Further research of rigour, designed to avoid the potential biases of previous evaluations, is needed.

Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments: La souffrance psychiatrique irrémédiable dans le contexte du suicide assisté : Une revue étendue des arguments

OBJECTIVES

Physician-assisted death (PAD), also known as medical assistance in dying, of patients with a psychiatric disorder (PPD) is a global issue of debate. In most jurisdictions that allow PAD, irremediable suffering is a legal requirement, how to apply the concept of irremediability to PPD remains challenging. The aim of this article is to identify the main arguments concerning irremediability in the debate about PAD of PPD and give directions for further moral deliberation and empirical research.

METHODS

Systematic searches in MEDLINE, Embase, and PsycINFO were combined with 4 additional search strategies. All conceptual-ethical articles, quantitative and qualitative empirical studies, guidelines, case reports, and commentaries that met the inclusion criteria were included, and a qualitative data synthesis was used to identify recurring themes within the literature. The study protocol was preregistered at the Open Science Framework under registration code: thjg8.

RESULTS

A total of 50 articles met the inclusion criteria. Three main arguments concerning irremediability were found in the debate about PAD of PPD: uncertainty, hope, and treatment refusal.

CONCLUSIONS

Uncertainty about irremediability is inevitable, so which level of certainty is morally required should be the subject of moral deliberation. Whether PAD induces or resolves hopelessness is an empirical claim that deserves clarification. Treatment refusal in search of PAD raises questions about treatment efficacy in this patient group and about decision-making in the context of the physician-patient relationship. Going forward, more attention should be given to epidemiological research and to specific challenges posed by different psychiatric disorders.

Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies

Negative effects of psychotherapy (NEP) include side effects, malpractice, and unethical behavior. Its setting-specific frequencies and predictors are mostly unknown. The two presented studies aim to investigate NEP and its predictors systematically across different treatment settings. In study 1, N = 197 patients of a German outpatient center were recruited, on average, 3.76 years after the termination of psychotherapy. In study 2, data from N = 118 patients of two German inpatient clinics were collected at admission (t₀), discharge (t₁), and 9-month follow-up (t₂). All participants evaluated the negative effects of their previous out- or inpatient psychotherapy with the Inventory for the Balanced Assessment of Negative Effects in Psychotherapy and a priori hypothesized predictors. At least one side effect was reported by 37.3% of inpatients (t₂) and 15.2% of outpatients. At least one case of malpractice and unethical behavior was reported by 28.8% of inpatients (t₂) and 7.1% of outpatients. Inpatients reported significantly more side effects (U = 14347, z = 4.70, p < 0.001, r = 0.26) and malpractice and unethical behavior (U = 14168, z = 5.21, p < 0.001, r = 0.29) than outpatients. Rates of severe malpractice in the form of breaking confidentiality and physical and sexual abuse were less than 1% in both settings. Predictors of side effects were prior experience with psychotherapy and current interpersonal difficulties in the outpatient setting and higher motivation for psychotherapy (t₀) in the inpatient setting. Predictors of malpractice and unethical behavior were younger age in the outpatient setting and poor therapeutic alliance, prior negative experience with malpractice and unethical behavior, and higher outcome expectations in the inpatient setting. NEP are common in both, in- and outpatient settings. Inpatients are at higher risk for the NEP than outpatients. To safeguard patients’ wellbeing, the systematic assessment and distinction of side effects and malpractice and unethical behavior should gain more attention in research and clinical practice.

Choice, coercion, and/or muddling through: Older adults' experiences in seeking psychological treatment

Help-seeking related to mental health concerns has been found to decrease as age increases . Despite extensive literature devoted to barriers to accessing mental health services, the reasons why older adults are especially unlikely to seek treatment are not well understood. The present study had two objectives concerning the experiences of older adults accessing outpatient psychological treatment: 1) classifying pathways into treatment using the Network Episode Model (NEM; Pescosolido et al., 1998), and 2) critically examining whether these pathways effectively captured the process of seeking treatment for older adults. Utilizing secondary qualitative data from three studies (N = 35), we met our first objective of classifying pathways according to the NEM with directed content analysis. The majority (n = 21, 60%) of older adults willingly accessed treatment (choice) and 42.9% of those involved 'others' in their help-seeking by way of referrals or support. The remaining participants' (n = 14, 40%) pathways into treatment reflected a process of muddling through (being unsure of their need for mental health services and where to access support, or bouncing around the treatment system). No participants' pathways were categorized as coercive. To meet our second objective, we used conventional content analysis to explore how best to categorize pathways to treatment. Findings demonstrated that a minority of participants (n = 10, 28.6%) had a help-seeking journey that represented only one of the three pathways. Instead, most participants described a lengthy period of muddling through, eventually followed by a willingness to seek help. These findings highlight the complex process of seeking treatment, and suggest a need to implement more direct mental health literacy interventions to reduce the amount of time spent muddling through, while improving the experience of mental health help-seeking for older adults.

Daily parenting of children with cerebral palsy: The role of daily child behavior, parents' daily psychological needs, and mindful parenting

The purpose of this study was to advance the current understanding of the daily dynamics that are involved in raising a child with Cerebral Palsy (CP). Specifically, we examined the role of mindful parenting and of day-to-day variation in parents' psychological needs and child behavior in explaining day-to-day variation in parents' autonomy-supportive, psychologically controlling, and responsive parenting behavior. Parents (N = 58) of children with CP (Mage = 12.68 years) participated in a 7-day diary study. Multilevel analyses indicated that parents' autonomy-supportive, psychologically controlling, and responsive behaviors fluctuate considerably between days. Further, daily fluctuations in both child behavior and parents' own psychological needs were found to be associated with this daily variability in parenting. In addition, interindividual differences in mindful parenting were associated positively with parents' responsiveness and negatively with psychologically controlling parenting across the week. These findings point towards the changeability of parenting behavior among parents of a child with CP and suggest that interventions targeting parenting behavior in the context of CP will be most effective when taking into account both the parents' and the child's functioning.

Similar but different: Profiling secondary school students based on their perceived motivational climate and psychological need-based experiences in physical education

The purpose of this study was to provide more insight into how the physical education (PE) context can be better tailored to the diverse motivational demands of secondary school students. Therefore, we examined how different constructs of student motivation in the context of PE combine into distinct motivational profiles, aiming to unveil motivational similarities and differences between students' PE experiences. Participants were 2,562 Dutch secondary school students, aged 12-18, from 24 different schools. Students responded to questionnaires assessing their perception of psychological need satisfaction and frustration, and perceived mastery and performance climate in PE. In order to interpret the emerging profiles additional variables were assessed (i.e. demographic, motivational and PE-related variables). Two-step cluster analysis identified three meaningful profiles labelled as negative perceivers, moderate perceivers and positive perceivers. These three profiles differed significantly with regard to perceived psychological need satisfaction and frustration and their perception of the motivational climate. This study demonstrates that students can be grouped in distinct profiles based on their perceptions of the motivational PE environment. Consequently, the insights obtained could assist PE teachers in designing instructional strategies that target students' differential motivational needs.