Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

Experiences with a guided trauma-focused internet- and mobile-based intervention: a qualitative study of youth's perspectives

Introduction: Research on internet-interventions for youth with post-traumatic stress symptoms (PTSS) is limited, despite promising results in adults. A non-randomised feasibility study of a therapist-guided trauma-focused internet- and mobile-based intervention (IMI) showed potential in reducing PTSS but revealed challenges with adherence and individual fit. Insights from qualitative studies can enhance intervention quality by addressing personal needs. This study explores participants' views on the feasibility of a therapist-guided trauma-focused IMI to improve digital trauma interventions.Methods: Semi-structured interviews based on theoretical models of acceptance and human support in IMIs were conducted with 17 of 32 participants from a self-help-based trauma-focused IMI with therapist guidance. Audio-recorded interviews were transcribed and analyzed using deductive-inductive content analysis. Independent coding resulted in good agreement (κ = .76).Results: 20 themes were identified and organised under nine dimensions: participation motivation and expectations; recruitment process; treatment adherence and everyday use of therapeutic exercises; trauma processing; non-trauma processing intervention components; technology, structure, and design of the IMI; human support; individual fit; and active factors and efficacy. The technology, structure, and design of the IMI and other non-trauma-focused components were rated positively. Trauma processing presented challenges for many but was still perceived as a helpful and relevant active factor. Some felt a lack of therapeutic support, and greater personalisation of guidance was a frequent suggestion for improving the individual fit. The IMI's efficacy was most often perceived in its effects on improved coping with trauma and symptoms.Discussion: The study identified key themes for the feasibility of a trauma-focused IMI for youth, showing general acceptance of its design, structure, and technology. While trauma processing in IMIs poses challenges similar to face-to-face therapy, these can be addressed by clarifying the therapy rationale, making trauma processing an important active factor. Further research is needed to improve individualisation and therapeutic support intensity.Trial registration: German Clinical Trials Register identifier: DRKS00023341..

Safety and tolerability of intramuscular sotrovimab administered at different injection sites: results from the Phase 1 COSMIC study

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT05280717.

I thought it would be difficult, but this is actually something I can do - experiences with Virtual Reality-based cognitive training in persons with TBI

INTRODUCTION

Virtual reality (VR) has been suggested as a promising technology for delivering cognitive training to persons with traumatic brain injury (TBI), as it can provide situations resembling everyday activities. Studies have demonstrated that persons with TBI manage utilizing VR in clinical settings; however, no studies have investigated VR use in home settings. The aim of this study was to explore how persons with TBI experience utilizing VR for rehabilitation at home and how they experience VR as cognitive training.

METHODS

Individual qualitative interviews were conducted with ten persons with TBI, aged 18-65. Participants had experience using VR, as they were recruited from the intervention group in a randomized controlled trial investigating VR in cognitive training. The data were analyzed using thematic analysis.

RESULTS

Participants highlighted the importance of creating new routines when fitting VR into everyday life. They addressed how being in a virtual world contributes to their motivation for cognitive training. Three themes were developed: 'Fitting VR-training into everyday life', 'Navigating through change' and 'Being in two worlds at the same time'.

CONCLUSION

This study shows that participants experienced VR as motivating, engaging, and easy to use, regardless of prior experiences with VR. The participants demonstrated how they included VR in everyday life by creating new routines when they performed cognitive training. Therewere few reports of adverse events. However, some experienced that VR had a negative impact on their energy level. Participants described the importance of therapeutic involvement for individual tailoring of the intervention.

Understanding Preferences for Visualized New and Future HIV Prevention Products Among Gay, Bisexual and Other Men Who Have Sex with Men in the Southern United States: A Mixed-Methods Study

Men who have sex with men (MSM) are vulnerable to HIV infection. Although daily oral pre-exposure prophylaxis (PrEP) prevents HIV among MSM, its usage remains low. We conducted virtual in-depth interviews (IDIs) and focus groups (FGs) with Black, Hispanic/Latino, and White MSM consisting of current PrEP users and those aware of but not currently using PrEP. We delved into their preferences regarding six emerging PrEP products: a weekly oral pill, event-driven oral pills, anal douche/enema, anal suppository, long-acting injection, and a skin implant. Our mixed methods analysis involved inductive content analysis of transcripts for thematic identification and calculations of preferences. Among the sample (n = 98), the weekly oral pill emerged as the favored option among both PrEP Users and PrEP Aware IDI participants. Ranking exercises during FGs also corroborated this preference, with the weekly oral pill being most preferred. However, PrEP Users in FGs leaned toward the long-acting injectable. Conversely, the anal suppository and douche/enema were the least preferred products. Overall, participants were open to emerging PrEP products and valued flexibility but expressed concerns about limited protection for products designed solely for receptive sex. Public health practitioners should tailor recommendations based on individuals' current sexual behaviors and long-term vulnerability to infection.

"It's OK for Me to Cry": Client and Therapist Perspectives on Change Processes in SPEAKS Therapy for Anorexia Nervosa

INTRODUCTION AND AIMS

Existing therapies for Anorexia Nervosa (AN) have limited effectiveness, necessitating the development of novel therapies and interventions. Hypothesizing and targeting clear mechanisms of change within treatment offer potential opportunities to improve them. The SPEAKS program aimed to develop, trial, and evaluate a therapy which targets key emotional and social factors known to be relevant in the development and maintenance of AN. The aim of the present study is to explore therapist and client experiences of change processes during the SPEAKS intervention, and what supported or inhibited these.

METHOD

Semi-structured interviews were conducted with sixteen female clients (in age range of 18-49) and six therapists; topic guides explored perceptions of client change processes. Thematic analysis was conducted on the data by two researchers.

RESULTS

Two themes and six sub-themes were developed from the data. These were: "the impact on the eating disorder," "change processes" ("emotional change" and "changing the self"), and "facilitators of and barriers to change processes" ("therapeutic relationship," "clients' emotional engagement," "online delivery," and "therapist lacking flexibility"). "Emotional change" involved an enhanced capacity for clients to tune-in more, acknowledge, listen to, and express how they felt, and "Changing the self" represented a shift in how clients related to themselves, particularly the more vulnerable parts of themselves.

DISCUSSION

The findings of the present study provide support for the hypothesized mechanisms of change inherent within the SPEAKS therapy approach. This supports the robustness and validity of the intervention and lends support for further investigation of its effectiveness.

CLINICAL TRIAL REGISTRATION

The study was registered according to the guidelines of the International Standard Randomized Controlled Trial Number Register (ISRCTN No. 11778891).

Acceptability of self-administered acupressure for knee osteoarthritis in middle-aged and older adults: A mixed-method secondary analysis

OBJECTIVES

To evaluate the acceptability of self-administered acupressure for Knee osteoarthritis (KOA) among middle-aged and older adults.

METHODS

This is a mixed-method acceptability evaluation was embedded in a randomized controlled trial on self-administered acupressure for KOA. Participants received two 2-h training sessions on self-administered acupressure and were instructed to practice twice daily for 12 weeks. Quantitative data were collected using an acceptability questionnaire (n = 153) and acupressure logbooks (n = 157). Qualitative data were obtained through semi-structured interviews, including post-training (n = 13) and post-intervention focus groups (n = 13), and individual interviews with participants who dropped out (n = 5). Data were analysed using descriptive statistics and framework analysis based on the Theoretical Framework of Acceptability.

RESULTS

The intervention had 91.7 % completion rate. Participants rated willingness to attend future sessions at 9.5/10 (SD=0.85). 57.8 % found technique education "very helpful" and 81.5 % followed the prescribed routine. Participants reported high overall acceptability of the self-administered acupressure training program, citing its practicality and potential benefits on knee pain, thigh strength, inflammation, and swelling. The minimal time and financial investment required were also appreciated. However, challenges related to personal efforts, time management, pressure from research monitoring, possible adverse events, and uncertainties with acupressure techniques were noted, leading to adherence issues. Participants expressed a need for continuous professional guidance.

CONCLUSION

Self-administered acupressure is highly acceptable to middle-aged and older adults with KOA due to its potential benefits and merits of minimal time and cost. Future research should focus on optimizing intervention implementation by providing professional support and efficient monitoring to address identified challenges.

Feasibility of ballistic vs conventional resistance training in healthy postmenopausal women: A three-arm parallel randomised controlled trial

OBJECTIVES

Power training has gained attention as a method for enhancing functional performance and mitigating fall risk in older adults, yet its long-term feasibility and safety, particularly in ballistic resistance training, remain underexplored in postmenopausal women. We evaluated the feasibility of 8-month ballistic resistance training compared with conventional resistance training in postmenopausal women.

STUDY DESIGN

The Resistance Exercise Programme on Risk of Osteoporosis and Osteoarthritis in Females (REPROOF) study was a three-arm parallel group randomised controlled trial at a university lab in the UK. Healthy postmenopausal women (n = 109) were randomised to 30 weeks (2 sessions/week) of lower-body ballistic resistance training, conventional resistance training, or a non-exercising control group.

MAIN OUTCOME MEASURES

The primary outcomes, collected by questionnaire, were process feasibility, acceptability, perceived exercise efficacy, and adverse events.

RESULTS

Eighty-two participants completed the trial (75.2 % retention). Both ballistic resistance training and conventional resistance training were well accepted, with most participants rating the intervention positively. No differences in the perceived improvements in physical function and psychological well-being were found between the resistance training groups. Similarly, there was no significant difference in the rate of muscle-related adverse events between the resistance training groups (ballistic, 2.7 per 100 person-weeks; conventional, 2.3 cases per 100 person-weeks), but the rate was significantly lower in the control group (0.9 cases per 100 person-weeks). No serious adverse events occurred during or within 24 h of exercise sessions.

CONCLUSIONS

The absence of serious adverse events and the observed positive outcomes confirm the safety, satisfaction, and perceived effectiveness of ballistic resistance training, suggesting its potential for broader application in healthy postmenopausal women.

CLINICALTRIALS

gov registry ID NCT05889598.

Men's Voices on Long-Acting Pre-Exposure Prophylaxis Delivery Modalities: Acceptability and Preferences Among Cisgender Men and Men Who Have Sex With Men in South Africa

INTRODUCTION

In sub-Saharan Africa, cisgender men-in particular men who have sex with women (MSW) and, to a lesser degree, men who have sex with men (MSM)-are often under-represented in HIV prevention research, despite their own HIV risk and role in transmission cycles. As HIV prevention research on long-acting pre-exposure prophylaxis (LA PrEP) options expands in sub-Saharan Africa, it is essential to engage these populations to ensure their acceptability. We investigated perceptions of implants and intramuscular injectables as LA PrEP delivery among MSW and MSM.

METHODS

In-depth interviews were conducted between October 2020 and March 2021 with 40 MSW (n = 20) and MSM (n = 20), aged 18-35 years, self-reported as HIV negative, sexually active, and residing in resource-restricted communities in Cape Town and Johannesburg, South Africa. We explored factors influencing LA PrEP attitudes. Data analysis followed a thematic framework approach.

RESULTS

MSW and MSM found LA PrEP administration modes more acceptable than daily oral PrEP because they offered longer lasting protection while reducing frequent clinic visits for refills. MSW voiced hesitancy around the use of "foreign products," fearing infertility and congenital disabilities in their future children. Both subgroups acknowledged the convenience of implants with long-dosing duration, but injections were deemed to be more discrete and familiar. Both groups described implant use as potentially stigmatizing, with a greater chance of causing tissue scarring from insertion and removal procedures.

CONCLUSIONS

Evidence relating to men's engagement in HIV prevention and acceptable modalities of HIV prevention is limited. We found that both groups were enthusiastic about LA PrEP, informing the development of our subsequent clinical study to provide further insight into using placebo versions of LA PrEP and future implementation of LA PrEP options.

Patient-Rated Acceptability of Automatic Palliative Care Referral: A Prospective Cohort Study

CONTEXT

Timely palliative care can alleviate distress after diagnosis of an incurable cancer. However, late referrals to palliative care continue, reflecting various provider and patient barriers.

OBJECTIVES

To determine patient/caregiver-reported acceptability of a phone call offering a supportive and palliative care (SPC) consultation without requiring oncologist referral.

METHODS

Two SPC nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients to offer an SPC consultation. Eligibility: >18 years, newly diagnosed/suspected stage IV nonsmall cell lung cancer, and completed first oncologist visit. Patients/caregivers were surveyed about the acceptability of the phone call offering SPC consultation, using Sekhon's Framework of Acceptability domains.

RESULTS

Among 113 patients screened, 81 patients/caregivers were contacted and offered an SPC consultation; 72% accepted the consultation. Of 48 patients/caregivers surveyed, 94% rated overall acceptability of the call somewhat/completely acceptable; 6% rated it neither acceptable nor unacceptable. Within specific acceptability domains, 95% were comfortable receiving the call; 92% understood why they received the call; 87% found the call valuable; 70% found the call helpful; 66% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97% thought the call required little physical/emotional effort and were confident in their ability to participate (i.e., to ask questions/make decisions).

CONCLUSION

These unsolicited phone calls offering SPC consultation were highly acceptable to patients/caregivers, and most agreed to the consultation. Implementing routine calls offering SPC consultation may be a timely alternative to awaiting conventional oncologist referral.

Implementation of clinical pharmacogenetic testing in medically underserved patients: a narrative review

As an emerging health technology, pharmacogenetic (PGx) testing has the capacity to improve medication therapy. However, implementation in medically underserved populations (MUPs) remains limited, which has the potential to increase healthcare disparities. While there is no single accepted definition for MUPs, demographic, socioeconomic, cultural, and geographic factors can lead to reduced access to healthcare, which contributes to disparate health outcomes in these populations. In the case of PGx testing, as MUPs have an increased risk of adverse drug events, have lower numbers of healthcare encounters, and are prescribed more medications which can be guided by PGx testing, additional benefits from PGx testing may occur in MUPs. Study of the acceptability and perceptions of PGx testing in MUPs, as reported in literature, provides support for the development of successful PGx testing implementations. Additionally, a few limited pilot PGx testing implementations in MUPs have assessed feasibility. However, further studies establishing the feasibility and effectiveness of PGx testing implementations in MUPs will enable more widespread PGx testing in those who are medically underserved. Thus, this narrative review explores the impact of medical underservice on health, PGx testing's potential impact on MUPs, and the research and early clinical implementations of PGx in MUPs.

Increasing breastfeeding initiation and duration in women with a body mass index ≥ 30 kg/m2: developing an intervention from theory to acceptability

BACKGROUND

Breastfeeding has many health benefits for both mother and child, but rates of initiation and duration amongst women with a BMI ≥ 30 kg/m2 are low. Few interventions aiming to increase breastfeeding in this group have been successful; likely because existing interventions do not target psychological factors. Therefore, this study aimed to design and explore the acceptability of a newly developed psychological intervention to increase breastfeeding initiation and duration in women with a BMI ≥ 30 kg/m2.

METHODS

The Medical Research Council's Complex Intervention Development Framework was followed to design the intervention. A 'breastfeeding workbook' was developed, based on literature and psychological theory, and filled with tailored information and activities. A Patient and Public Involvement group of women with a BMI ≥ 30 kg/m2 who had breastfed, health professionals and researchers were consulted throughout the process, selecting the intervention content, format and delivery methods. Thirteen women with a BMI ≥ 30 kg/m2 then reviewed the workbook and took part in in-depth qualitative interviews to assess its acceptability. Thematic analysis was conducted, informed by the Theoretical Framework of Acceptability version 2.

RESULTS

The findings reveal the intervention is acceptable to the target population; women believe the intervention shows promise for increasing breastfeeding initiation and duration, is representative of their experiences, is accessible, and aligns with their belief system. They valued that the intervention provided realistic expectations of breastfeeding, options to overcome the challenges of breastfeeding in the real-world and supported them to breastfeed without inducing stigma or shame regarding their weight or infant feeding practices. Suggestions for improvement are also included, such as incorporating audio and video content as alternatives to written text and translation options.

CONCLUSIONS

An acceptable, psychological intervention was developed to increase breastfeeding initiation and duration in women with BMIs ≥ 30 kg/m2. These findings can inform maternity and breastfeeding care, future research directions and intervention development.

Pilot study of an ecological momentary music intervention for stress reduction in Turkish immigrant women perceiving chronic ethnic discrimination

Perceived ethnic discrimination is a stressor that negatively affects mental and physical health. To address this issue, we tested the feasibility and preliminary effectiveness of an ecological momentary music intervention for stress reduction in everyday life in Turkish immigrant women perceiving chronic ethnic discrimination. Following an intra-individual randomized design, we combined subjective assessments and biological measures (salivary cortisol and alpha-amylase). Using a smartphone-based app, twenty participants responded to stress- and discrimination-related items four times a day for 35 days, and additionally reported each stressful/discriminatory event they perceived. Participants were then randomly instructed to listen to music or not. At each measurement time point, participants provided saliva samples. The feasibility of the ecological momentary music intervention was indicated by high usage rates of the app and participants' positive self-reports. We found immediate (post 1: b =  - 14.64, p = .045, post 2: b =  - 14.62, p = .047) and intermediate (b =  - 0.81, p < .001) effects of music listening on subjective stress levels but not on biological stress levels. Our study provides valuable insights into the potential of music listening for stress reduction in the everyday life of Turkish immigrant women perceiving chronic ethnic discrimination.

General practice preconception care invitations: a qualitative study of women's acceptability and preferences

BACKGROUND

In general practice, primary care providers can potentially use electronic medical records (EMRs) to identify and invite reproductive-aged women with preconception health risk factors to increase their engagement in preconception care (PCC). However, the acceptability of receiving PCC invitations and women's preferences about the invitation process are poorly understood. This study aims to investigate women's acceptability and preferences for receiving PCC invitations from general practice settings.

METHODS

Participants were recruited via convenience, purposive and snowball sampling. Semi-structured interviews were conducted via Zoom from August until November 2023. Interviews were transcribed verbatim and inductive reflexive thematic analysis was undertaken.

RESULTS

PCC invitations sent from general practice are acceptable if the language is sensitive and non-stigmatising. Text or email invitations detailing the importance and scope of the PCC consultation were preferred, after discussing reproductive intentions with a general practitioner or practice nurse. Women with preconception health risk factors or those actively trying to conceive were more likely to engage in PCC. Key strategies to enhance PCC engagement include advertising in waiting rooms, introducing PCC in new patient registration forms, and integrating PCC into holistic care.

CONCLUSION

Using EMRs to identify and invite women with preconception health risk factors to increase their engagement in PCC is generally acceptable. Invitations sent via text messages or emails are preferred. It is crucial to use respectful and appropriate language to avoid stigmatising or offending women, particularly those with infertility issues, those who have completed their families, or those who do not wish to have children.

Usability and acceptability of ambulatory monitoring in undiagnosed syncope: insights from the ASPIRED-Q qualitative study

OBJECTIVES

The aim of this study, which was embedded into the ASPIRED randomised controlled trial (ISRCTN10278811), was to explore patient and healthcare professional usability and acceptability of an enhanced (14-day) ambulatory ECG monitoring patch to manage and facilitate discharge of emergency department patients with unexplained syncope.

DESIGN

A qualitative study using semistructured interviews. Data were analysed using thematic analysis and mapped using the theoretical framework of acceptability.

PARTICIPANTS

A sample of 20 syncope patients recruited to the ASPIRED RCT and 10 healthcare professionals who had a direct care provider and clinical decision role for syncope patients (eg, consultants, junior doctors, advanced nurse practitioners, advanced care practitioners, emergency nurse practitioners and physician associates) were recruited from four hospitals (two in England and two in Scotland) between February 2023 and January 2024.

RESULTS

Three overarching themes developed that mapped to six of the seven constructs within the theoretical framework of acceptability. The themes were: (1) Efficacy: Patients and healthcare professionals felt that the remote intervention would increase patient reassurance. Healthcare professionals perceived the intervention would improve clinical care pathways by overcoming delays for Holter monitors, but that a standard protocol would be required to ensure appropriate intervention use. (2) Burden: Patients considered that the device was non-obstructive and easy to use. However, healthcare professionals noted that although attaching the device was simple, there would be associated time and resource costs (eg, documentation). (3) Communication and education: Comprehensive verbal and written information were considered necessary to ensure that the intervention was usable by, and acceptable to, patients. Healthcare professionals suggested additional training would be required. Additionally, they considered that feedback from patient monitoring would reinforce their decision-making and improve healthcare professionals' self-efficacy to use the device appropriately.

CONCLUSIONS

An immediate, enhanced (14-day) ambulatory ECG monitoring patch was positively received by patients and offered healthcare professionals an acceptable route for monitoring emergency department patients with unexplained syncope. However, future use should be controlled using standardised pathways to prevent inappropriate use.

TRIAL REGISTRATION NUMBER

ISRCTN10278811.

Patient and healthcare professionals' perception of weekly prophylactic catheter washout in adults living with long-term catheters: qualitative study of the CATHETER II trial

OBJECTIVES

To explore trial participants' experience of long-term catheters (LTC), the acceptability of washout policies, their experience of the CATHETER II trial (a randomised controlled trial comparing the clinical effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters) and their satisfaction with the outcomes. The objectives of the healthcare professionals (HCPs) focus group and interview were to explore their attitudes towards weekly prophylactic catheter washout, views on the provision of training and participants' ability to enact washout behaviours.

METHODOLOGY

A longitudinal qualitative study embedded within the CATHETER II randomised controlled trial, which included semi-structured interviews and focus groups with participants from multiple trial sites. Data were analysed using the Theoretical Framework of Acceptability and Theoretical Domains Framework. This UK community-based study included 50 (24 female, 26 male) CATHETER II trial participants, aged between 23 and 100 years, with LTC and able to self-manage the washout and study documentation either independently or with the help of a carer. Seven HCPs (five female, two male) also participated.

RESULTS

The participants had positive attitudes towards weekly prophylactic saline or acidic catheter washouts and other trial elements, such as washout training, catheter calendar and monthly phone calls. Participants and HCPs found the 'ask' of the CATHETER II trial and the weekly self-administered prophylactic washout policies to be feasible. The participants reported that the catheter washout training provided during the trial enhanced their self-efficacy, skills and self-reported capability to carry out the washouts. Participants reported having positive outcomes from the weekly washout. These included reduced blockage, pain or infection, reduced need for HCP support and greater psychological reassurance. HCPs attested to the participants' understanding of and adherence to the weekly washouts and other elements of the trial.

CONCLUSIONS

This study shows acceptability, feasibility and self-reported fidelity of the CATHETER II trial on a behavioural level. Self-management for prophylactic catheter washouts is both feasible and, following training, achievable without any need for additional support.

TRIAL REGISTRATION NUMBER

ISRCTN17116445.

Acceptability of an online peer support group as a strategy to improve antiretroviral therapy adherence among young people in Kampala district, Uganda: qualitative findings

INTRODUCTION

Peer support groups may contribute to adherence and play a role in decreasing the stigma of antiretroviral therapy (ART) adherence among young people living with HIV (YPLHIV). However, peer support activities usually occur face-to-face in Uganda and elsewhere in Sub-Saharan Africa and thus have structural limitations and may not be readily available when young people need them. Online peer support has the potential to help YPLHIV access regular psychosocial support without significant effort or cost. We assessed the acceptability of a WhatsApp peer support group as a strategy to improve ART adherence among Ugandan YPLHIV.

METHODS

We conducted a formative qualitative study in three health facilities in Kampala, Uganda, between July and August 2022. We held four focus group discussions with twenty-six YPLHIV seeking services at the study facilities. We also conducted six key informant interviews with health providers attached to adolescent HIV care clinics. Data was analyzed using thematic analysis guided by Sekhon's theoretical framework of acceptability (2017), which conceptualizes acceptability through multiple constructs, including affective attitudes, burden, intervention coherence, and perceived effectiveness. Our analysis examined these dimensions in the context of WhatsApp-based peer support groups for HIV care.

RESULTS

Overall, WhatsApp peer support groups were acceptable for use among YPLHIV. The young people regarded it as convenient because it would save time and would be more cost-effective compared to the transport costs of in-person meetings. Health providers revealed that the WhatsApp peer support group could reduce the stigma associated with community follow-up and empower YPLHIV to overcome stigma. Both young people and health providers suggested that online peer support could enhance emotional support, psychosocial well-being, and ART adherence. However, participants raised concerns about privacy and the cost of internet bundles and smartphones, especially for younger adolescents.

CONCLUSION

Online peer support groups are acceptable to Ugandan YPLHIV and hold promise in enhancing psychosocial support and improving treatment adherence in this sub-population. In implementing online support groups, due consideration should be given to software tools with high privacy standards and zero-rated data use for new apps. Research is needed to evaluate the feasibility and effectiveness of this peer support model in Uganda.

Psychological and self care outcomes for children and adolescents living with type 1 diabetes and their caregivers attending diabetes camp: A mixed methods study

AIM

Diabetes camps for children and adolescents living with Type 1 Diabetes (T1D) offer an important opportunity to foster self-efficacy and 'common humanity', a sense that they are not alone in their challenges. The current study primarily aimed to assess whether psychological wellbeing, diabetes self care behaviours and HbA1c improved amongst campers and their caregivers, and whether these would be sustained at 3- and 6-months.

METHODS

Children and adolescents aged 7-13 years who attended the 2023 diabetes camp in Auckland, Aotearoa New Zealand and one of their caregivers were invited to participate. Campers and caregivers were assessed at camp enrolment and then at 1-week, 3-months and 6-months post-camp. Guided by the Theoretical Framework of Acceptability, optional qualitative interviews were also used to explore campers' experiences of camp.

RESULTS

Of the 31 children and adolescents who attended the 2023 camp, 27 (87%) participated in the study with a caregiver. Campers showed reduced feelings of isolation (p = 0.036) and overidentification (p = 0.036) 6 months. Caregivers demonstrated overall improvements in self-efficacy (p = 0.034), caregiver distress and burden (p = 0.006) and caregiver quality of life (p = 0.039). Qualitative findings confirmed high acceptability, with participants reporting positive camp experiences.

CONCLUSIONS

Diabetes camps can improve caregivers' self-efficacy, diabetes distress and quality of life, and reduce feelings of isolation and overidentification among campers. Future work is needed to promote cultural inclusivity within camps and improve their accessibility, to be able to optimise the wellbeing of all children and adolescents living with T1D and their families.

Reconceiving Domestic Burning Controls: Air Quality Alerts, Behavioural Responsive Regulation, and Designing for Compliance

Domestic combustion emissions pose a growing risk to public health, especially in the UK. Existing responses are polarised, with government advocating use of lower emission fuels and stoves while clean air campaigners call for blanket bans on burning. However, each approach is limited in its ability to control these emissions. An alternative can be found in the U.S.A., where 'burn alert' systems require stove and fireplace users to avoid lighting during periods of actual or projected poor air quality. Given the effectiveness of these regimes, the current study designs and evaluates the effectiveness and acceptability of a burn alert system in the UK for the first time, drawing on the theoretical perspective of behavioural responsive regulation. Fifty participants were recruited to use the system over 2 weeks in winter. The findings illustrate that a voluntary burn alert system can dissuade burning among users. Of those in receipt of an alert, 74% reduced burning frequency or burned for a shorter duration. In total, the alert system prevented at least 178 hours of burning for this group. Qualitative findings show that the consistency of the behavioural response is influenced by technical, structural, and environmental factors, providing key insight into how UK-based burn alert systems could be modified to increase the consistency of compliance in future. The overall conclusion is that burn alerts could be introduced in the UK and beyond, as a means of reducing domestic combustion emissions and their associated public health risks.

Student-Led Mobility Interventions for Hospitalized Adults: A Mixed-Methods Feasibility and Acceptability Study

BACKGROUND

Inactivity in hospitalized patients often leads to functional decline. We created an undergraduate course to promote mobilization, provide hands-on learning, and address staff shortages.

PURPOSE

To assess the feasibility and acceptability of undergraduate students providing mobility-focused interventions for hospitalized adults.

METHODS

This mixed-methods study was conducted at a level 1 trauma academic center. We analyzed program feasibility and acceptability using quantitative data and thematic analysis of interviews and focus groups.

RESULTS

In total 47 individuals (n = 14 students, n = 9 patients, and n = 24 clinicians) were included. Students averaged 4.1 mobility sessions per 4-hour shift. All stakeholders agreed the program is acceptable, and 98.6% affirmed the program is feasible. The themes identified included positive impacts on patient care, enhanced student professional development, and practical implementation challenges.

CONCLUSIONS

Student-led mobility interventions can be an acceptable strategy to mitigate immobility harm in hospitalized patients. The integration of students enhances patient care and provides valuable educational experiences.

An mHealth app technology to strengthen adverse event management of multi-drug-resistant tuberculosis in Vietnam: Protocol for a process evaluation of the V-SMART trial

BACKGROUND

Drug-related adverse events cause poorer treatment outcomes amongst people with multi-drug-resistant tuberculosis, exacerbating a major global public health problem. The Harnessing new mHealth technologies to Strengthen the Management of Multi-Drug-Resistant Tuberculosis in Vietnam (V-SMART) trial tests whether a mobile health (mHealth) application (app) can optimise management of drug-related adverse events, within routine health services in Vietnam. Implementation of digital health within routine services is complex and driven by behaviour change as well as a range of health system factors. Understanding implementation is key to informing the evidence base for digital health prior to scale up, despite its potential appeal.

METHODS

Through a process evaluation of the V-SMART trial, we aim to (i) understand the multi-drug-resistant tuberculosis service delivery context and how trial procedures are implemented within services; (ii) describe 'dose' and 'reach' of the app; and (iii) understand health worker and patient perspectives of app implementation and identify areas for improvement. To achieve this, we will (i) conduct process maps (patient flow maps) to describe implementation of the mHealth intervention within routine multi-drug-resistant tuberculosis health services including adverse event management pathways at different levels of the health system; (ii) measure app usage by all participating health workers and people with multi-drug-resistant tuberculosis over time; and (iii) conduct a total of up to 45 semi-structured interviews in seven provinces, with people with multi-drug-resistant tuberculosis, health workers, and policymakers, to identify determinants of app uptake and suggestions for future person-centred app design. Interview topic guides are informed by the Theoretical Framework for Acceptability, Normalisation Process Theory, and the Tailored Implementation of Chronic Diseases framework respectively.

DISCUSSION

The process evaluation will strongly complement the parent trial impact evaluation, and the economic evaluation. Moreover, it will inform future tailored approaches to scaling up digital health as part of broader health system strengthening initiatives.

Consensus-Based Recommendations for Designing, Delivering, Evaluating, and Reporting Exercise Intervention Research Involving People Living With a Spinal Cord Injury

OBJECTIVES

To establish recommendations for designing, delivering, evaluating, and reporting exercise intervention research to improve fitness-related outcomes in people living with spinal cord injury (PwSCI).

DESIGN

International consensus process.

SETTING

(1) An expert panel was established consisting of 9 members of the governing panel of the International Spinal Cord Society Physical Activity Special Interest Group and 9 additional scientists who authored or co-authored ≥1 exercise randomized controlled trial paper involving PwSCI. (2) We invited the panelists to draft an outline of the recommendations for 1 intervention component. (3) The panel reviewed the draft outlines and determined whether they fit the scope and objectives of the project, whether they were evidence-based, and whether they were sufficiently detailed. (4) We interviewed 7 PwSCI who had participated in ≥1 exercise trial to gather insights on their experiences within the trials, what they liked, and what they would change. (5) A first draft of the recommendations was approved by the panel and circulated to the general members of the International Spinal Cord Society Physical Activity Special Interest Group to gather their suggestions and opinions via an online survey. (6) The member feedback was used to revise the recommendations and panel members approved a final version.

PARTICIPANTS

N/A.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURE(S)

N/A.

RESULTS

We generated 33 recommendations regarding participant recruitment, study sample size determination, outcome measurement, potential confounders, exercise intervention prescription and delivery, supporting adherence to the intervention, monitoring and reporting adherence and retention, fidelity of the delivery of the intervention, monitoring and reporting adverse events, study design, and registration of study protocol and preparation of a protocol paper.

CONCLUSIONS

International experts have come to consensus on recommendations for conducting exercise intervention research involving PwSCI. Adopting these recommendations will increase the quality of the research and the overall certainty of the evidence regarding the effects of exercise on health outcomes in PwSCI.

Long-acting parenteral formulations of hydrophilic drugs, proteins, and peptide therapeutics: mechanisms, challenges, and therapeutic benefits with a focus on technologies

Despite being the most widely prescribed formulation, oral formulations possess several limitations such as low adherence, low bioavailability, high toxicity (in the case of anticancer drugs), and multiple-time administration requirements. All these limitations can be overcome by long-acting injectables. Improved adherence, patient compliance, and reduced relapse have been observed with long-acting formulation which has increased the demand for long-acting injectables. Drugs or peptide molecules with oral bioavailability issues can be easily delivered by long-acting systems. This review comprehensively addresses the various technologies used to develop long-acting injections with a particular focus on hydrophilic drugs and large molecules as well as the factors affecting the choice of formulation strategy. This is the first review that discusses the possible technologies that can be used for developing long-acting formulations for hydrophilic molecules along with factors which will affect the choice of the technology. Furthermore, the mechanism of drug release as well as summaries of marketed formulations will be presented. This review also discusses the challenges associated with the manufacturing and scale-up of the long-acting injectables.

User journey method: a case study for improving digital intervention use measurement

BACKGROUND

Many digital mental health interventions meet low levels of use. However, current use measurement methods do not necessarily help identify which intervention elements are associated with dropout, despite this information potentially facilitating iterative intervention development. Here, we suggest improving the comprehensiveness of intervention use measurement with the user journey method, which evaluates every intervention element to identify intervention-specific use barriers.

METHODS

We applied user journey method in a clinical trial that investigated the efficacy of a novel game-based intervention, Meliora, for adult Major Depressive Disorder. We modelled the intervention for its four technological (Recruitment, Website, Questionnaires, Intervention Software) and two interpersonal elements (Assessment, Support). We then applied the user journey method to measure how many users proceeded from one element to the next combining social media analytics, website use data, signup data, clinical subject coordinator interview data, symptom questionnaire data, and behavioral intervention use data. These measurements were complemented with the qualitative analysis of the study discovery sources and email support contacts.

RESULTS

Recruitment: The intervention recruitment reached at least 145,000 Finns, with social media, word-of-mouth, and news and web sources being the most effective recruitment channels. Website: The study website received 16,243 visitors, which led to 1,007 sign-ups.

ASSESSMENT

895 participants were assessed and 735 were accepted. Intervention Software: 498 participants were assigned to the active intervention or comparator, of whom 457 used them at least once: on average, for 17.3 h (SD = 20.4 h) on 19.7 days (SD = 20.7 d) over a period of 38.9 days (SD = 31.2 d). The 28 intervention levels were associated with an average dropout rate of 2.6%, with two sections exhibiting an increase against this baseline. 150 participants met the minimum adherence goal of 24 h use. Questionnaires: 116 participants completed the post-intervention questionnaire.

SUPPORT

313 signed-up participants contacted the researchers via email.

CONCLUSION

The user journey method allowed for the comprehensive evaluation of the six intervention elements, and enabled identifying use barriers expediting iterative intervention development and implementation.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05426265. Registered 28 June 2022, https://clinicaltrials.gov/ct2/show/NCT05426265 .

Fidelity, acceptability, and feasibility of the revised functional autonomy measurement system for hospitalised people: An implementation study

INTRODUCTION

The revised functional autonomy measurement system (SMAF-R) is an outcome measure of activity performance and resource needs. This study aimed to measure the implementability of the SMAF-R as a routine outcome measure in acute and subacute inpatients.

METHODS

This was a mixed-methods implementation study. Occupational therapists were asked to complete the SMAF-R in hospitalised people with an anticipated length of stay greater than 48 hours over a 12-month period (n = 13,348). A baseline audit of SMAF-R completion rates was conducted, and behaviour change interventions were delivered over 12 months. The Implementability of Healthcare Interventions conceptual framework was used to evaluate fidelity (completion rates), acceptability (staff survey with quantitative and qualitative responses), and feasibility (change in SMAF-R scores from admission to discharge). Quantitative and qualitative (analysed thematically) data were integrated.

CONSUMER INVOLVEMENT

Occupational therapists and other staff working to improve outcome measure completion within the electronic medical record and other allied health teams were consulted when developing and delivering behaviour change interventions.

FINDINGS

Peak completion of the SMAF-R did not meet an 80% fidelity success rate (admission: 32% in acute and 66% in subacute; discharge: 12% in acute and 48% in subacute). Two thirds of occupational therapists reported the SMAF-R was an acceptable measure to use, but only 38% liked using it. Thematic analysis revealed three themes: (1) A greater understanding of the relevance of the SMAF-R influenced acceptability; (2) using the SMAF-R within an electronic medical record may facilitate completion; and (3) it takes more time to complete SMAF. Patients made clinically significant improvements in SMAF-R scores during their hospital stay (median difference 16.5 [6.5-27.0], p < 0.001, n = 764).

CONCLUSION

Although most occupational therapists reported the SMAF-R was acceptable, there were mixed opinions regarding the relevance of the SMAF-R in this setting, which may have impacted fidelity. Additional prompting and training (especially regarding understanding SMAF-R relevance to practice) may assist with improving SMAF-R completion. Further research is required to assess the psychometric properties of the SMAF-R in the hospital environment.

PLAIN LANGUAGE SUMMARY

The revised functional autonomy measurement system (SMAF-R) is an assessment tool used to measure performance in everyday activities (such as showering) and the resources needed to complete these tasks (e.g., a shower chair or someone's help). Occupational therapists can use it at the start of a patient admission and again at the end in different hospital settings to assess patients' needs and see if they improve. This study aimed to measure (1) how often occupational therapists use the SMAF-R with patients in hospital, (2) how acceptable occupational therapists find the SMAF-R, and (3) whether the SMAF-R shows changes in patients' abilities during their hospital stay. Before the study, usual completion of the SMAF-R was measured, and it was found to be completed in less than 1% of patients. Strategies were introduced to improve SMAF-R completion over 12 months. After this, completion of the SMAF-R improved to between 9% and 38% in different hospital settings. Changes in SMAF-R scores showed that patients improved during their time in hospital. Most occupational therapists reported the SMAF-R was an acceptable measure, but less than half liked using it. The low completion rates suggested that either the SMAF-R was not fit for purpose in this setting or that more support is needed to increase completion.

Acceptability of a nurse-led survivorship intervention for men with prostate cancer receiving androgen deprivation therapy: A qualitative exploratory study

PURPOSE

To assess the acceptability of a five-session, nurse-led, survivorship intervention for men with prostate cancer receiving Androgen Deprivation Therapy (ADT), delivered via a specialist prostate cancer telehealth service.

METHODS

A qualitative exploratory study using the Theoretical Framework of Acceptability. The study was undertaken in an established Australian specialist prostate cancer tele-nursing service. Study participants were men with a diagnosis of prostate cancer who: (i) were about to start or were within 3 months of commencing ADT; (ii) had a treatment plan for at least 12 months of continuous ADT; (iii) had no current psychiatric illness or history of head injury and/or dementia; and (iv) had no other concurrent cancer (excluding non-melanoma skin cancer). A purposive sampling strategy was used for recruitment.

FINDINGS

Nineteen participants took part in semi-structured interviews, comprising men who had completed the program (n = 18) and the nurse who had delivered it (n = 1). Overall acceptability was high across all constructs of the TFA, and particularly strong across the domains of ethicality and self-efficacy. Quality of design, structure and content was seen as highly favourable, as was the strength of the therapeutic relationship that developed between the nurse and the participants. Clinically, the program delivered sizeable gains in knowledge about ADT impact on physical, psychological, and sexual wellbeing, and confidence to identify and proactively manage side effects.

CONCLUSIONS

Findings from this study suggest that a nurse-led, psychoeducation program for men on ADT is highly acceptable, with great potential for implementation at scale via a national specialist nursing program.

Core elements and principles of nutrition models of care for people with cancer: A scoping review

BACKGROUND AND AIMS

The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of nutrition models of care for people with cancer.

METHODS

MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003-8 November 2023. Studies were eligible for inclusion and data extraction if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RQVHJ) on 7 November 2023.

RESULTS

The search identified 4599 papers, 28 studies met inclusion criteria. Studies were primarily conducted in Australia (71.4 %), within a hospital (96.4 %), metropolitan setting (89.3 %) and with various cancer diagnoses. Most studies described a nutrition screening process and 50 % used a valid and reliable assessment tool. Studies described provision of direct care by the dietitian (n = 26), primarily conducted in the outpatient setting (n = 26) and lesser in the inpatient setting (n = 12), and frequently face-to-face (n = 25) [phone (n = 14), telehealth (n = 3)]. Ten core elements were identified that underpinned the models of care including: timely care driven by a care pathway, protocol or clinic (100.0 %); nutrition expertise and leadership (100.0 %); flexible and integrated (100.0 %); with multi-directional communication (96.4 %); accessible (92.9 %); stratified by risk (89.3 %); multidisciplinary engagement (85.7 %); across different care time-points and settings (85.7 %); supported by training/education (50.0 %) and data integration (25.0 %).

CONCLUSIONS

Nutrition expert-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care, with the most utilised being: timely care driven by a care pathway, protocol or clinic; nutrition expert-led; flexible and integrated; with multi-directional communication; accessible; and stratified by risk. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.

Telemedicine-delivered treatment for substance use disorder: A scoping review

IntroductionThe COVID pandemic prompted a significant increase in the utilization of telemedicine (TM) for substance use disorder (SUD) treatment. As we transition towards a "new normal" policy, it is crucial to comprehensively understand the evidence of TM in SUD treatment. This scoping review aims to summarize existing evidence regarding TM's acceptability, quality, effectiveness, access/utilization, and cost in the context of SUD treatment in order to identify knowledge gaps and inform policy decisions regarding TM for SUDs.MethodWe searched studies published in 2012-2022 from PubMed, Cochrane Library, Embase, Web of Science, and other sources. Findings were synthesized using thematic analysis.ResultsA total of 856 relevant articles were screened, with a final total of 42 articles included in the review. TM in SUD treatment was perceived to be generally beneficial and acceptable. TM was as effective as in-person SUD care in terms of substance use reduction and treatment retention; however, most studies lacked rigorous designs and follow-up durations were brief (≤3 months). Telephone-based TM platforms (vs video) were positively associated with older age, lower education, and no prior overdose. Providers generally consider TM to be affordable for patients, but no relevant studies were available from patient perspectives.ConclusionsTM in SUD treatment is generally perceived to be beneficial and acceptable and as effective as in-person care, although more rigorously designed studies on effectiveness are still lacking. Access and utilization of TM may vary by platform. TM service quality and costs are the least studied and warrant further investigations.

Actively Waiting: Feasibility and Acceptability of a Virtual Self-Management Program Designed to Empower People With Chronic Pain Waiting for Interprofessional Care

Chronic pain affects 1.9 billion people worldwide and wait times for interprofessional pain management programs can be extensive. The existing wait times provide an opportunity to introduce internet-based interventions that enhance self-management ability.

PURPOSE

The purpose of this study was to examine the feasibility, acceptability, engagement, and meaningfulness of an online program designed to enhance the readiness for change and self-management.

DESIGN

Participants (N = 61) waiting for interprofessional chronic pain care at two centers were assigned to engage in either a series of eight self-directed web-based modules or engage in the modules with the addition of four one-on-one sessions delivered by coaches trained in motivational interviewing techniques.

METHODS

We collected participant demographics, feasibility and engagement metrics, and pre and post intervention questionnaires. A subset of participants from each group participated in an interview (n = 22).

RESULTS

The use of online modules was found to be feasible and acceptable for participants and engagement varied depending on individual preference and between modules. Participants noted that the content and approach were relevant and meaningful, influencing changes in thinking and behaviour around pain self-management. Exploratory analyses were performed and supported improvement in self-efficacy and chronic pain acceptance outcomes in both groups. Coaching did not augment improvements in any of our outcomes.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The use of a self-directed web-based chronic pain and motivational empowerment program appears to be a promising option to support people waiting for specialist care and may influence readiness for interprofessional care.

Development of a Suicide Prevention Intervention for Sexual and Gender Minority Youth and Young Adults: Rationale, Design, and Evidence of Feasibility and Acceptability

BACKGROUND

Patient navigation (PN), paired with the safety planning intervention (SPI), may allay mechanisms that theoretically underlie suicide among sexual and gender minorities (SGM). This paper describes (a) the iterative development of a theory-informed PN + SPI intervention (QueerCare) to prevent suicide among at-risk SGM youth and young adults and (b) a case series examining the feasibility and acceptability of study procedures, measures, and QueerCare.

METHODS

Seven initial QueerCare modules and a glossary of terms were drafted. Seven participants completed the case series. Feasibility and acceptability over 3 months were examined by triangulating multi-method data.

RESULTS

The study procedures and measures in the at-risk population were feasible and sensitive, provided that remote safety monitoring and parental consent waivers were in place. QueerCare was feasible, helpful, and appropriate based on satisfaction ratings and four emerging themes: matched identity care, internalized barriers, support, and flexibility valued. Two additional modules and guardian materials were created. Suicidal crisis management protocols were continuously refined.

CONCLUSION

QueerCare was developed as a highly flexible modular intervention to meet the needs of SGM youth and young adults and prevent repeat suicide attempts in this population. Findings indicate study procedures, measures, and QueerCare were feasible and acceptable based on triangulated data.

TRIAL REGISTRATION

This study was registered under ClinicalTrials.gov identifier NCT04757649.

Consumer Experience of an Australian Multidisciplinary Long COVID Clinic That Incorporates Personalised Exercise Prescription: A Qualitative Analysis

BACKGROUND

In Australia, Long COVID is prevalent in 5%-10% of COVID-19 cases. Few multidisciplinary services exist to support recovery from Long COVID.

OBJECTIVE

To understand the consumer experience and acceptability of a novel Australian Long COVID Recovery Clinic, which incorporates personalised exercise prescription including respiratory and peripheral strengthening and carefully monitored cardiovascular training.

DESIGN

Qualitative study; semi-structured interviews conducted by a researcher external to the clinic delivery.

SETTING, PARTICIPANTS

A convenience sample of participants who have completed the Long COVID Recovery Clinic.

MAIN OUTCOME MEASURES

Major themes were identified by inductive thematic analysis.

RESULTS

Fifteen participants were interviewed. 14/15 (93%) participants described the clinic model as acceptable or highly acceptable. Five core themes were identified, including (1) encouraging staff and light-filled facilities support recovery; (2) supervised exercise and pacing improve confidence with exercise; (3) peer support and group therapy augments recovery; (4) other services augment Long COVID recovery, and (5) importance of GP involvement in connection with clinic participation. Suggestions for improvement included extending the duration of the clinic programme beyond 2 months, reducing wait times by increasing staffing levels and adjusting the clinic schedule to broaden access options.

CONCLUSIONS

The majority of participants found that the Long COVID Recovery Clinic, which incorporates both supervised exercise and pacing, is acceptable and would recommend it to others. From the consumer perspective, the Long COVID Recovery Clinic aids recovery alongside GP management through a combination of peer support and an individually tailored programme.

PATIENT OR PUBLIC CONTRIBUTION

A consumer was a highly valued member of our research team. She has been involved in study design, analysis, and interpretation. She has also been involved in editing the manuscript and provided advice to ensure the language used in the manuscript is sensitive to a consumer audience. As our consumer meets the authorship guidelines, we have included her as an author in this manuscript. We also intend to include our consumers in the dissemination of these results when published (e.g., social media).

TRIAL REGISTRATION

The study was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12622000719730.

Feasibility and acceptability of PDConnect, a multi-component intervention to support physical activity in people with Parkinson's disease: A mixed methods study

BackgroundPhysical activity (PA) is beneficial for people with Parkinson's (PwP); however, many are classed as sedentary. PDConnect is an online multicomponent intervention combining 1:1 physiotherapy and group-based PA combined with education, behavior change and self-management strategies, promoting PA and self-management among PwP.ObjectiveTo assess feasibility and acceptability of PDConnect.MethodsMixed methods study involving 31 PwP randomly allocated to: (i) usual care: physiotherapy once a week for six weeks, and (ii) PDConnect: physiotherapy once a week for six weeks, followed by 12 weekly sessions of group-based PA, followed by three monthly Teams calls to support engagement. Outcomes included intervention feasibility and acceptability (primary) assessed via survey and interviews; PA, motor, non-motor symptoms, and health and well-being (secondary) assessed at baseline, and at six, 18, and 30 weeks. Fidelity was accessed by post hoc video analysis.ResultsOnline delivery of PDConnect was feasible and safe. Participant retention was 74%. Response rate of self-reported measures was 97%. 95% of participants returned completed activity diaries. Attendance was high, with all participants recommending PDConnect. PDConnect participants reported improved flexibility, muscle strength, and endurance as well as increased PA confidence, PA levels and knowledge of Parkinson's disease. Half of PDConnect participants reported that they were much improved compared to 10% of usual care participants. Small to large effect sizes in PA (d = 0.03) and UPDRS (d = 0.96) ES) were reported, which warrant further exploration in an appropriately powered study.ConclusionsPDConnect is feasible and acceptable among PwP. A future large-scale trial is required to determine the effectiveness of PDConnect.

Evaluating the Usability, Acceptability, User Experience, and Design of an Interactive Responsive Platform to Improve Perinatal Nurses' Stigmatizing Attitudes Toward Substance Use In Pregnancy

BACKGROUND

Perinatal nurses are increasingly encountering patients who have engaged in perinatal substance use (PSU). Despite growing evidence demonstrating the need to reduce nurses' stigmatizing attitudes toward PSU, limited interventions are available to target these attitudes and support behavior change - especially those that reflect the overwhelming evidence that education alone is insufficient to change practice behavior. Arts-based interventions are associated with increasing nursing empathy, changing patient attitudes, improving reflective practice, and decreasing stigma. We adapted ArtSpective™ for PSU, a previously evaluated arts-based intervention to reduce stigma among perinatal nurses, into an interactive digital responsive platform that facilitates intervention delivery asynchronously.

OBJECTIVE

This study aimed to evaluate the usability, acceptability, and feasibility of the interactive, responsive platform version of ArtSpective™ for PSU, designed to deliver an adapted version of the in-person intervention to improve nurses' stigmatizing attitudes toward PSU, following a mixed methods approach. Our goal was to elicit user experience strengths and weaknesses related to the design of the responsive platform and identify strategies to overcome them.

METHODS

This study used a mixed-methods approach to explore the platform's usability and user experience and its acceptability as an intervention to address stigma and implicit bias related to PSU. Theatre testing was used to qualitatively assess usability and acceptability perspectives with nurses and experts, as well as a modified version of the previously validated 8-item Abbreviated Acceptability Rating Profile for quantitative assessment. Analyses of quantitative data regarding acceptability and satisfaction were performed using descriptive statistics (mean, standard deviation, frequency, percentage). All qualitative data were analyzed iteratively using an inductive framework analysis approach.

RESULTS

A total of 21 nurses and four experts in stigma, implicit bias, and instructional design completed theatre-testing sessions. The mean duration of interviews for nurses was 31.92 (SD 11.32) minutes, and for experts, 40.73 (SD 8.57) minutes. All participants indicated that they found the digital adaptation of the intervention to be highly acceptable, with mean acceptability items ranging from 5.0 (SD 1.0) to 5.5 (SD 0.6) on a 1-6 agreement scale. Nurses reported high satisfaction with the platform on a 1-6 agreement scale, with mean satisfaction items ranging from 5.14 (SD 0.56) to 5.29 (SD 0.63) on a 1-6 agreement scale. 1,797 interview segments were coded from the theatre-testing sessions with four major themes: appearance, navigation, characterization, and overall platform, and 16 subthemes were identified. Consistent with the quantitative findings, the results were positive overall, with participants expressing high satisfaction related to the platform's appearance, ease with which they could navigate the various modules, engagement, clarity of the presentation, and feasibility to be completed asynchronously.

CONCLUSIONS

Developing and evaluating the usability of a digital adaptation of ArtSpective™ for PSU resulted in strong support for the usability, acceptability, and satisfaction of the program and provided insight into key aspects related to acceptability and usability that should be considered when designing a digital adaptation of an arts-based intervention for healthcare providers.

CLINICALTRIAL

Feasibility, Acceptability, and Potential Effects of a Digital Oral Anticancer Agent Intervention: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Individuals taking oral anticancer agents (OAAs) often face important challenges, requiring more timely informational support, ongoing monitoring, and side effect management.

OBJECTIVE

This study, guided by the Self-Efficacy Theory, aims to assess the feasibility, acceptability, and potential effects of a comprehensive, digital OAA intervention.

METHODS

A 2-arm, mixed methods, pilot randomized controlled trial took place at a large university-affiliated cancer center in Montreal, Quebec, Canada. Participants (N=52) completed baseline self-report e-questionnaires and subsequently were randomly assigned to the experimental group (intervention plus usual care, n=26) or control group (usual care only, n=26). The study intervention, designed to increase medication adherence via medication adherence self-efficacy and decreased symptom distress, included (1) OAA informational videos, (2) OAA-related e-handouts and other supportive resources, (3) nurse-led follow-up calls, and (4) e-reminders to take OAAs. The e-questionnaires were completed once a week for the first month and every 2 weeks for the subsequent 4 months, or until OAA treatment was completed. A subset from both groups (n=20) participated in semistructured interviews once they completed the study requirements. Study feasibility is assessed using recruitment, retention, and response rates, as well as intervention uptake. Through e-questionnaires and exit interviews, intervention acceptability is to be assessed prospectively at baseline and retrospectively upon study completion. Potential effects are then assessed via medication adherence self-efficacy, medication adherence self-report, and symptom distress.

RESULTS

Data collection was completed by December 2023 with a final sample size of 41. Results are expected to be published in 2025.

CONCLUSIONS

This study relies on a theoretically based, OAA digital intervention with modalities tailored to the needs and preferences of participants. The use of quantitative and qualitative methods enriches our understanding of the potential contributions of the intervention. In addition, following participants over the course of treatment captures potential changes in oral treatment-related processes and outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04984850; https://www.clinicaltrials.gov/study/nct04984850.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55475.

Gait Rehabilitation for Early rheumatoid Arthritis Trial (GREAT): lessons learnt from a mixed-methods feasibility study and internal pilot trial

Background

People with rheumatoid arthritis experience foot and lower limb pain due to active synovitis, resulting in impaired lower limb function. Earlier intervention may help with prevention of functional decline. The aims of this research were to develop and evaluate a new gait rehabilitation intervention for people with early rheumatoid arthritis, evaluate its feasibility, and to test whether or not gait rehabilitation plus usual care is more clinically and cost-effective than usual care alone.

Design and methods

We undertook a single-arm, repeated-measures, pre- and post-intervention, mixed-methods feasibility study with embedded qualitative components. We planned to undertake a pragmatic, two-arm, multicentre, superiority randomised controlled trial, with health economic evaluation, process evaluation and internal pilot.

Setting and participants

Participants with early rheumatoid arthritis (< 2 years post diagnosis) were identified from early arthritis and rheumatology outpatient clinics and referred for intervention in either podiatry or physiotherapy clinics.

Intervention(s)

Participants were randomised to a gait rehabilitation programme (Gait Rehabilitation Early Arthritis Trial Strides) involving a six-task gait circuit. Sessions were underpinned by motivational interviewing to facilitate behaviour change, supported by trained physiotherapists or podiatrists for a minimum of two sessions. Both groups received their normal usual care from the rheumatology multidisciplinary team.

Main outcome measures

Outcome measures for the feasibility study were intervention acceptability, adherence using the Exercise Adherence Rating Scale and fidelity using the Motivational Interviewing Treatment Integrity Scale. The main outcome measure for the internal pilot/randomised controlled trial was the Foot Function Index disability subscale. Outcomes were measured at baseline, 3 months, 6 months and 12 months. Other outcomes: intervention acceptability questionnaire, Exercise Adherence Rating Scale, exercise treatment beliefs via the Theory of Planned Behaviour Questionnaire, intervention fidelity (Motivational Interviewing Treatment Integrity Scale), health-related quality of life (EuroQol-5 Dimensions, five-level score).

Results

Thirty-five participants were recruited for feasibility and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent: 21/23 were confident that it could help and would recommend it and 22/23 indicated it made sense to them. Adherence was good, with a median (interquartile range) Exercise Adherence Rating Scale score of 17/24 (12.5-22.5). Twelve participants' and nine therapists' interviews confirmed intervention acceptability, identified perceptions of benefit, but highlighted some barriers to completion. Motivational Interviewing Treatment Integrity Scale scores demonstrated good fidelity. The trial did not progress from internal pilot to full main trial as a result of low recruitment and high attrition, after 53 participants were recruited from 9 sites over 12 months. Process evaluation confirmed good intervention acceptability and adherence, and fair fidelity. Evaluation of clinical and cost-effectiveness was not possible.

Limitations

Significant delays were experienced with the impact of coronavirus disease 2019, regulatory approvals, contracts and site readiness, resulting in few sites opening in time and low recruitment capacity. Foot and/or ankle pain prevalence was lower than anticipated, resulting in a low potential participant pool and a low conversion rate from screening to enrolment.

Conclusions

The Gait Rehabilitation Early Arthritis Trial Strides intervention was acceptable to people with early rheumatoid arthritis and intervention clinicians, safe, with good levels of adherence by participants, and fair intervention fidelity. The randomised controlled trial stopped early following failure to meet recruitment targets. Gait Rehabilitation Early Arthritis Trial Strides is a promising intervention that could be adapted for future evaluations. A definitive trial of the Gait Rehabilitation Early Arthritis Trial Strides gait rehabilitation intervention still needs to be done.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/165/04.

Development of a Multiuser Interactive Health Response Application (MITHRA) for depression in women from a community-based organisation in India

BACKGROUND

In India, women in rural areas have high rates of depression. They have poor access to mental healthcare resources and, hence, mental health symptoms remain largely unaddressed. Existing mobile telephone applications (apps) do not engage end-users, lack local language options, may not be socioculturally relevant and do not use audiovisual formats. We thus developed a mobile mental health app, Multiuser Interactive Health Response Application (MITHRA), to screen and provide brief behavioural intervention for mild to moderate depression among rural women attending self-help groups (SHGs) in India.

AIMS

This qualitative study explores the process and findings of focus groups conducted with SHG administrators and women to inform the iterative development of the MITHRA app.

METHOD

In total, 22 participants were interviewed (17 SHG participants and five administrators), and a thematic analysis of the data was conducted using the acceptability of interventions framework.

RESULTS

Frequent themes across the focus groups were affective attitude, burden, self-efficacy and perceived effectiveness. All women showed a positive attitude towards the app and depression interventions, while older women demonstrated less self-efficacy in using mobile mental health apps.

CONCLUSIONS

MITHRA is a promising app in the management of mild to moderate depression in women in SHG. With adequate training and education of family members, MITHRA has the potential to identify and treat women with mild to moderate depression.

Efficacy of open-label placebos for premenstrual syndrome: a randomised controlled trial

OBJECTIVE

To investigate the efficacy and safety of open-label placebos (OLP) in premenstrual syndrome (PMS).

DESIGN

Randomised controlled trial.

SETTING

Switzerland, 2018-2020.

PARTICIPANTS

150 women (18-45 years of age) with PMS or premenstrual dysphoric disorder.

INTERVENTION

Random assignment (1:1:1) to treatment as usual (TAU), OLP without treatment rationale (OLP-), or OLP with treatment rationale (OLP+). OLP consisted of two placebo pills per day for 6 weeks.

MAIN OUTCOME MEASURES

Primary outcomes were PMS symptom intensity and interference between groups across three menstrual cycles (MC1-MC3); adverse events (ie, safety) were measured at weeks 3 and 6 after the start of the intervention. Secondary outcomes were psychological and somatic subscales of PMS symptom intensity, and adherence.

RESULTS

From 2 August 2018 to 3 December 2020, 150 women were randomly allocated to TAU (n=50), OLP- (n=50), and OLP+ (n=50), of whom 145 (96.7%) completed trial participation. Groups differed in symptom intensity (F(4)=4.419, p=0.002, r2=0.16) and interference (F(4)=3.159, p=0.014, r2=0.13) across three MCs. Mean symptom intensity at MC3 was lower for OLP+ compared to TAU (b=-9.97, SE=2.85, t(412)=3.50, p<0.001, d=0.90) and to OLP- (b=-6.10, SE=2.89, t(411)=2.11, p=0.036, d=0.55), but OLP- and TAU did not differ (b=-3.87, SE=2.87, t(411)=1.35, p=0.177, d=0.35). Mean interference at MC3 was lower for OLP+ compared to TAU (b=-1.23, SE=0.54, t(443)=2.30, p=0.022, d=0.55) and to OLP- (b=-1.10, SE=0.54, t(442)=2.02, p=0.044, d=0.48), but OLP- and TAU did not differ (b=-0.14, SE=0.54, t(442)=0.26, p=0.799, d=0.06). Four non-serious adverse events were reported in OLP- (n=1) and OLP+ (n=3). Improvement in psychological and somatic symptom intensity was comparable to primary outcomes. Adherence to the OLP intervention was high (93.18±18.95%), with no difference between groups.

CONCLUSIONS

The results of our clinical trial indicate that OLP provided with a treatment rationale is an effective, safe, and acceptable treatment for PMS.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03547661 (submitted 2 May 2018).

The People's Review protocol: planning an innovative study powered by the public

BACKGROUND

Systematic reviews provide the best quality evidence about the effectiveness of health treatments. However, systematic reviews and the important role they play in healthcare are not well understood beyond the walls of academia and healthcare. Systematic reviews can help the public make more informed health choices, based on the best available evidence. The People's Review aims to provide an opportunity to members of the public to plan and complete a full systematic review online in a supportive and engaging manner. It will be a learning-by-doing experience to support the public's understanding of what reviews are, how they are done, why they matter, and how they can be used to support everyday health decisions.

METHODS

In The People's Review the public will conduct a full systematic review, deciding the review question, planning the review, working on the parts of the review, and deciding how to share the review findings, in a 'learning by doing' process. The review will be conducted online in eight stages using Cochrane Crowd, an existing citizen science platform. The team working behind-the-scenes of The People's Review will design, produce, and share learning material to support the public's understanding at each stage of the review.

DISCUSSION

Involving the public in a systematic review online will enable members of the public to understand and use systematic reviews in everyday health choices. It provides the public with a unique 'learning by doing' opportunity to get to grips with what systematic reviews are and how they are produced. This article describes how we plan to involve the public in The People's Review. It is not a protocol for the systematic review itself - this will be published separately once the project has commenced, and the public have decided the review question.

Measuring Patient-Reported Acceptability Outcomes via the Program Acceptability Tool for Telehealth

Introduction: Assessing treatment acceptability is critical to understanding patient experiences in clinical trials, especially in telehealth settings where exposure and engagement experiences are unique. However, the use of patient-reported acceptability outcomes in mental health-focused trials has been mixed, with most published studies relying on objective behavior (e.g., dropout rates) or fit-for-use measures, rather than instruments rooted in a specific theoretical model. This study introduces the Program Acceptability Tool for Telehealth (PATT), a novel, theoretically grounded instrument designed to capture patient-reported acceptability in telehealth-based trials. Methods: Here, we describe the initial development and validation of the PATT, including its performance with 123 caregivers participating in an ongoing clinical trial that includes multiple types of interventions and support programs focused on caregiver well-being. Results: The final 12-item PATT demonstrated robust psychometric properties, including high internal consistency (α = 0.82-0.90) and content validity. Convergent validity was established through significant correlations between PATT scores and behavioral engagement metrics. Conclusions: Our findings suggest that the PATT is a reliable, valid tool for capturing patient acceptability, offering a nuanced perspective on program, process, and impact-related experiences. Further validation studies are recommended to confirm the PATT's utility in broader applications.

Patients' acceptability of a patient-reported outcome measure in cardiac rehabilitation (the PRO-Heart-DK)-a mixed methods study using the Theoretical Framework of Acceptability

BACKGROUND

The integration of Patient Reported Outcome Measures (PROM) in cardiac rehabilitation practice has potential to enhance patient involvement and management. User acceptance is crucial for successful implementation of healthcare interventions, but limited literature addresses PROM acceptability among cardiovascular patients. This study explored the acceptability of a new national PROM in cardiac rehabilitation clinical practice for patients with ischemic heart disease (IHD) in Denmark.

METHODS

Patients who responded to the PROM were invited to complete two brief surveys evaluating perceived relevance, usefulness, and satisfaction. A purposefully selected subsample participated in semi structured interviews to gather in-depth experiences. A parallel convergent mixed-methods design was used with the Theoretical Framework of Acceptability applied to structure and interpret findings.

RESULTS

105 and 119 patients respectively responded to the two evaluation surveys (response-rates 56.5% and 53.4% respectively) and 25 patients were interviewed. The study showed a strong willingness to engage with PROMs, indicating a high overall acceptability. Most patients perceived the PROM helpful for preparation and enhancing communication during consultations. A minority of patients reported emotional reactions and experienced issues with questionnaire comprehensiveness, structure, and relevance.

CONCLUSION

The findings indicate that most IHD patients find PROM relevant and useful in cardiac rehabilitation. To enhance acceptability and, hence, future implementation, improvements are needed in clinical settings by providing adequate patient information, effectively using PRO results, and addressing patients' emotional reactions. Additionally, PROM development should focus on ensuring the questionnaire's relevance, comprehensiveness, and structure.

Conducting Assessments of Community-Based Programs for Individuals With Dementia and Their Family Caregivers

Although the gold standard for intervention science is the randomized controlled trial (RCT), there is growing emphasis on the practical implementation and evaluation of evidence-based programs in community agencies. Assessment of program efficacy by community-based organizations can confirm planned delivery of services, implementation fidelity, and demonstrate positive outcomes, which can provide justification for funding. Methods and measures used in an RCT, however, often cannot be implemented in nonresearch settings, and different approaches are needed. This manuscript reviews the emerging literature on program evaluation work and draws upon the authors' experiences conducting evaluations with three community-based organizations funded by the Administration for Community Living to implement programs for individuals with dementia and their family care partners. This article argues for an examination of the expectations of evaluation efforts for translation of research-based trials to practice and emphasizes three main strategies for assessment: (1) development of brief-tailored assessments; (2) measuring fidelity of implementation of the program; and (3) measuring acceptability of the program to clients.

Rehabilitation after bone marrow transplant compared with usual care to improve patient outcomes (REBOOT): protocol for a randomised controlled trial

BACKGROUND

Haematological cancer affects more than 1.3 million people around the world annually and accounted for almost 800,000 deaths globally in 2020. The number of patients with these cancers undergoing bone marrow transplant is increasing. Of note, this intensive treatment is associated with complex and multifactorial side effects, often impacting nutritional status, physical functioning and overall health-related quality of life. The primary aim of this study is to investigate the effectiveness of an eight-week multidisciplinary rehabilitation intervention compared with usual care on the physical function domain of the European Organisation for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30 version 3) in patients with haematological cancer following bone marrow transplant.

METHODS

This is a multisite, pragmatic two-arm parallel-group, randomised controlled trial (RCT) with stratified randomisation, powered for superiority, recruiting 170 participants at 30 days following either allogeneic or autologous bone marrow transplant (ACTRN12622001071718). Recruitment sites include three Australian university affiliated teaching hospitals. Participants are eligible if aged ≥ 18 years, treated for haematological cancer with allogeneic or autologous bone marrow transplant and can walk independently. The intervention group will receive eight weeks of twice weekly telehealth-based exercise classes, an initial and follow up dietetics consult, post exercise protein supplements, and a home-based physical activity program, all with embedded behaviour change strategies. The primary outcome is patient reported physical function measured using the EORTC QLQ-C30 version 3. Secondary outcomes include other domains of the EORTC QLQ-C30, fatigue, physical function, physical activity levels, frailty, body composition, sarcopenia and nutrition assessment. We will also undertake a health economic analysis alongside the trial and a process evaluation exploring intervention fidelity, causal mechanisms as well as contextual influences through qualitative enquiry.

DISCUSSION

The REBOOT trial will add RCT-evidence from a rigorously conducted, statistically powered multi-site trial to existing limited knowledge on the effects of multi-disciplinary rehabilitation for people with haematological cancer. If effectiveness is supported, then implementation of rehabilitation into care pathways for people having bone marrow transplant can be considered.

TRIAL REGISTRATION

ACTRN12622001071718 prospectively registered 03/08/2022, last updated 08/03/2024.

Implementation of a nurse-delivered, community-based liver screening and assessment program for people with metabolic dysfunction-associated steatotic liver disease (LOCATE-NAFLD trial)

BACKGROUND

With the high burden of Metabolic dysfunction-associated steatotic liver disease (MASLD), (previously known as Non-Alcoholic Fatty Liver Disease - NAFLD) in the community, current models of care that require specialist review for disease risk stratification overwhelm hospital clinic capacity and create inefficiencies in care. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) randomised trial compared usual care to a community-based nurse delivered liver risk assessment. This study evaluates the implementation strategy of the LOCATE model.

METHODS

The evaluation used mixed methods (quantitative trial data and qualitative framework analysis of semi-structured interviews) to explore the general practitioner (GP) and patient perspectives of acceptability (Acceptability Framework), and factors associated with reach, effectiveness, adoption, implementation, and maintenance (RE-AIM framework) of the LOCATE model of care.

RESULTS

The LOCATE model was considered highly acceptable by both patients and GPs. The model of care achieved appropriate reach across the participating health services, reaching high-risk patients faster than usual care and with predominantly positive patient experiences. A notable reduction in anxiety and stress was experienced in the intervention group due to the shorter waiting times between referral and assessment. There was an overall perception of confidence in nursing staff capability to perform the community-based screening and GPs indicated confidence in managing low-risk MASLD without the need for specialist review. Challenges to implementation, adoption and maintenance included variable prioritisation of liver disease assessment in complex cases, the need for further GP training in MASLD assessment and treatment pathways, available funding and referral pathways for community screening, and accessibility of effective diet and exercise professional support.

CONCLUSION

Nurse delivered community-based liver screening is highly acceptable to GPs and patients and has shown to be an effective mechanism to identify high risk patients. Adoption and maintenance of the model of care faces significant challenges related to affordable access to screening, prioritisation of liver disease in complex patient cohorts, and unresolved difficulties in prescribing effective strategies for sustained lifestyle intervention in the primary care setting.

TRIAL REGISTRATION

The trial was registered on 30 January 2020 and can be found via Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12620000158965.

The acceptability, feasibility, and usability of a virtual reality pain education and rehabilitation program for Veterans: a mixed-methods study

Introduction

Persistent pain is a leading cause of medical discharges for Veterans. Pain science education (PSE) aims to better people's understanding about pain and is effective at reducing pain and depressive symptoms in Veterans. Preliminary evidence suggests virtual reality (VR)-delivered PSE has clinical benefits for people with persistent pain. This study investigated the acceptability, feasibility, and usability for VR-PSE for Veterans with persistent pain.

Methods

Veterans (n = 7) and healthcare professionals (HCPs) experienced in treating Veterans (n = 5) participated in workshops that involved working through the VR-PSE program, online questionnaires, and a focus group. Quantitative data were analysed by descriptive statistics. Qualitative data were analysed using a framework analysis according to the Theoretical Framework of Acceptability (TFA). A mixed-methods analysis combined the quantitative and qualitative data via triangulation, with the findings presented according to the TFA domains.

Results

The VR-PSE program was considered easy to use, engaging, and adaptable for different functional capabilities. Appropriate screening for contraindications prior to using the VR-PSE program was considered important by HCPs. Both Veterans and HCPs emphasized the need for a trusting client-clinician relationship to improve the acceptability of the VR-PSE program.

Discussion

Overall, the VR-PSE program was found to be acceptable, feasible, and usable and may be a useful tool to incorporate into the clinical management of Veterans with persistent pain. Further research is needed to investigate the efficacy of VR-PSE programs on clinical outcomes for Veterans with persistent pain.

Nucleus accumbens deep brain stimulation in adult patients suffering from severe and enduring anorexia nervosa (STIMARS): protocol for a pilot study

Background

Affecting adolescent and young adults, anorexia nervosa (AN) has the highest death rate of all mental disorders. Effective treatment options are lacking and a significant proportion of patients develop severe and chronic forms of the disease with long-lasting functional impairment. Neurobiology of AN implicates the nucleus accumbens as a core structure of the ventral striatum highly connected to the prefrontal cortex, the insula and the limbic system. Several studies reported promising results of deep brain stimulation for treatment-resistant AN. The aim of this study was to investigate the safety and efficacy of bilateral nucleus accumbens deep brain stimulation in severe and enduring AN.

Methods and analysis

This is a prospective, multicentre, single-arm, open-label, non-randomized pilot trial of bilateral nucleus accumbens deep brain stimulation for severe and enduring AN. Patients will be followed up for 24 months after deep brain stimulation. The main objective of this study is to measure the safety and feasibility of nucleus accumbens deep brain stimulation in this population. The recruitment rate will be collected prospectively. Potential deep brain stimulation efficacy will be monitored by changes in: 1) health-related quality of life; 2) weight; 3) eating disorder symptomatology; 4) neuropsychological changes of cognitive flexibility, habits formation, emotional processing and central coherence; 5) psychiatric comorbidities (anxiety, depression, obsession). Local field potential recordings during an exposure task will be proposed to the patients. Additionally, caregiver quality of life will be assessed.

Discussion

We present the design and rationale for a pilot study investigating the safety of nucleus accumbens deep brain stimulation for treatment resistant anorexia nervosa. This trial will provide an estimated effect size of nucleus accumbens deep brain stimulation for treatment-resistant anorexia nervosa to support future larger-scale clinical trials.

Acceptability and feasibility randomised controlled trial of a digital mental health intervention for people with Parkinson's (PACT): trial protocol

BACKGROUND

People with Parkinson's disease can experience psychological distress and have difficulties accessing face-to-face psychological support due to symptom burden and limited availability of psychological services. Digital options for psychological support can bridge this gap. We have developed an app based on acceptance and commitment therapy (ACT) to support people with Parkinson's to improve psychological wellbeing.

AIM

To assess the acceptability of the app and the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of using the app to improve wellbeing for people with Parkinson's.

METHODS

We will conduct a parallel-group randomised controlled feasibility trial comparing a digital app based on ACT (intervention group) to usual care (waitlist control group). We will recruit 60 people with Parkinson's, 40 to the intervention group and 20 to the control group. Primary feasibility outcomes include recruitment and retention rate, intervention engagement and satisfaction. Secondary outcomes include measures of clinical effectiveness (anxiety and depression), quality of life and cost-effectiveness. Interviews will be conducted to assess acceptability of the app. Primary feasibility outcome data will be analysed descriptively and compared against pre-defined feasibility criteria. Secondary outcomes will be analysed based on an intention-to-treat principle, and a cost-consequence analysis will be used to estimate cost-effectiveness. Interviews will be analysed using a deductive thematic analysis based on the Theoretical Framework of Acceptability.

DISCUSSION

This trial will provide data on the feasibility of conducting a full-scale RCT of the effectiveness and cost-effectiveness of the app to improve psychological wellbeing for people with Parkinson's disease.

Understanding the activity and participation limitations in adolescents with cleft lip and palate: A mixed design study using the concept of International Classification of Functioning, Disability and Health Children and Youth Version

ObjectiveThe primary objective is to comprehensively examine the activity and participation limitations in adolescents with cleft lip and palate utilizing the ICF-CY (International Classification of Functioning, Disability and Health Children and Youth Version).DesignMixed designed study.

SETTING

Hacettepe University Plastic and Reconstructive Surgery Department.

PARTICIPANTS

264 adolescents with cleft lip and palate and 300 healthy adolescents.

MAIN MEASURES

The Mann-Whitney U test was used to compare occupational balance levels, and qualitative content analysis was used for analyzing interviews. Data were then coded according to the categories of the ICF-CY.ResultsThere was a statistically significant difference between temporality (P = .001), rest and sleep (P = .004), occupational variations and adaptations(P = .001), occupational meaning and value (P = .0001), and A-OBS (Adolescent Occupational Balance Scale) total scores. Participants expressed that they especially had problems in carrying out daily life activities and ensuring social participation. They further stressed that their families tended to provide an overly protective environment. Additionally, adolescents reported improved communication within virtual environments. Adolescents emphasized the impact of the ongoing surgical history on personal development.ConclusionsICF-CY provides an important perspective in examining the activity and participation limitations of children with cleft lip and palate, providing an opportunity to understand the effects of impairments in body structure and function, environmental barriers, and social impacts.

Acceptability of fixed-dose combination treatments for hypertension in Kenya: A qualitative study using the Theoretical Framework of Acceptability

Fixed-dose combinations (FDCs) - 2-3 anti-hypertensive medications in a single pill - have the potential to improve hypertension treatment and outcomes. Yet, they are not widely implemented. Factors undermining implementation remain unknown, particularly in sub-Saharan Africa, where hypertension is a major cause of disease burden and is poorly controlled. This study explored the acceptability of FDCs among patients, caregivers, and healthcare workers. We conducted semi-structured in-depth interviews with 58 participants from four purposively selected health facilities in Kiambu county, Kenya. Data were analyzed using an iterative thematic analysis approach, guided by the Theoretical Framework of Acceptability. Our findings indicate that FDCs are potentially acceptable to all participant groups. Acceptability is supported by the perception of FDCs as a means of reducing treatment burden (for patients and healthcare workers) and improving treatment adherence, and by patients' deferral to and trust in healthcare workers. However, acceptability among healthcare workers may be undermined by variable levels of knowledge about FDCs, concerns about FDCs as an "inflexible" treatment that does not allow dose titration or identifying causes of side effects, and concerns about inconsistent availability and affordability of FDCs in Kenya. To enhance acceptability and implementation of FDCs for hypertension treatment in Kenya, it is crucial to strengthen the capacity of all healthcare worker cadres to appropriately prescribe, inform patients about, and support adherence to FDCs. These efforts must align with broader initiatives to address upstream health system factors such as poor availability and affordability.

Factors shaping Covid-19 vaccine acceptability among young people in South Africa and Nigeria: An exploratory qualitative study

Covid-19 vaccine hesitancy among young people can be seen as an acute - but not isolated - phenomenon within an alarming longer-term trend of broader vaccine distrust in Africa. Yet there are still considerable knowledge gaps in relation to the scope and drivers of low vaccine acceptability among young people. Moreover, better frameworks and tools are needed to conceptualise and better understand acceptability in this population group. We applied the recently published Accelerate Framework for Young People's Acceptability to guide qualitative research with young people living in South Africa and Nigeria. We aimed to investigate their overall acceptability of the Covid-19 vaccine, and explore factors shaping this acceptability and willingness to be vaccinated. In collaboration with seven community-based organisation partners, we conducted 12 in-person focus groups and 36 remote interviews with 163 individuals aged 15-24. Through a collaborative, iterative process we conducted thematic analysis, incorporating aspects of both deductive and inductive approaches. Our findings show how vaccine acceptability is shaped by a multiplicity of inter-related factors. They also provide a more in-depth perspective of some of these phenomena, their relative importance and their connections in this group of young people. Limited vaccine understanding, conflicting information and distrust, the influence of others, and fear of side effects were key inter-related drivers of low vaccine acceptability. Factors promoting Covid-19 vaccine acceptability were instead: positive perceptions of vaccine safety and efficacy, protection from disease, protection of others, and a desire to return to normal activity. We discuss implications of these findings for policy and practice, both to increase acceptability of Covid-19 vaccination among young people, and more broadly promote vaccination as a critical component of public health programs. Lastly, we reflect on this first application of theAccelerate Framework, and implications for its use in future studies.

The feasibility of culturally adapted computerised cognitive remediation for first-episode psychosis

BACKGROUND

British South Asians have a greater incidence of psychotic illness, which is associated with cognitive deficits. Computerised cognitive remediation aims to improve cognition.

AIMS

We aimed to culturally adapt computerised cognitive remediation for British South Asians with first-episode psychosis, and assess its feasibility.

METHOD

Qualitative interviews were analysed using thematic analysis to guide cultural adaptation of cognitive remediation, followed by a case series to determine feasibility. Our sample comprised 20 participants: ten in the qualitative interviews and ten in the feasibility evaluation. The sample was generated via purposive sampling from early intervention services in England, and was an entirely Muslim cohort, who were mainly Pakistani and born in the UK. Our intervention was computerised interactive remediation of cognition training for schizophrenia (CIRCuiTS), which was culturally adapted based on formative qualitative interviews and using an established framework. Participants engaged with 40 h of tasks over 12 weeks, with the aim of improving attention, memory and executive functioning. Feasibility was explored by assessing acceptability, engagement and retention in the study, and a range of measures were used to assess impact on cognition and mental state.

RESULTS

The cultural adaptation of CIRCuiTS was found to be acceptable, with high levels of engagement and satisfaction. Despite the small sample, the intervention led to improved cognition and mental state.

CONCLUSIONS

This is the first study to culturally adapt computerised cognitive remediation for British South Asians who are Muslim, and it had high acceptability with good retention, engagement and satisfaction. Future effectiveness testing is recommended.

A Tailored Home-Based Training Program Improved Ataxia Severity and Participation in Adults With ARSACS

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare degenerative movement disorder impacting balance and mobility. Rehabilitation helps to reduce disease severity and increase the quality of life of people with ARSACS. However, rehabilitation programs require many trips to dedicated facilities, posing a significant challenge for individuals living with ARSACS. This study aimed to develop a home-based training program specific for adults with ARSACS and to document its effects on ataxia severity, balance, mobility, and participation. This non-blinded and non-randomised interventional study used a pre-post design with a control phase. The initial level of training difficulty was tailored to each participant using a standardized assessment tool. Participants trained three times a week for 12 weeks. Outcome measures included the BERG Balance Scale, Ottawa Sitting Scale, 10-meter Walk Test, 30-second Chair Stand Test, 10-Steps Test, LIFE-H, and Scale for the Assessment and Rating of Ataxia. The retrospective acceptability of the program was also assessed using Sekhon's theoretical framework of acceptability. Fourteen participants (eight walkers, 50% men) completed the program (self-reported attendance rate rate: 75-100%) and seven dropped out. All outcome measures remained stable during the control phase. Ataxia severity and participation significantly improved after the 12-week home-based training program. At an individual level, clinical improvements in standing and sitting balance were noted for almost half of the participants, particularly for non-walkers. The eight participants who assisted to the focus group reported that the program was acceptable. This study indicates that tailored home-based training is safe, acceptable, and helps to reduce ataxia severity and participation restriction for adults with ARSACS.