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Mcintyre D, Chiang J, Thiagalingam A, Tong A, Chow CK. Engagement and fidelity of a cardiovascular disease prevention-focused digital health intervention in cardiology outpatient waiting rooms: a mixed-methods study. BMJ Qual Saf 2023; 32:655-664. [PMID: 35803709 DOI: 10.1136/bmjqs-2021-014664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We delivered a video-based, cardiovascular disease prevention focused intervention in cardiology waiting rooms that increased motivation to improve cardiovascular risk behaviours and satisfaction with clinic services. To better understand the potential generalisability and scalability of such waiting room interventions, this study evaluated the fidelity of intervention delivery and barriers and enablers to implementation. METHODS Mixed-methods process evaluation conducted among intervention participants in a randomised clinical trial. Data sources included (1) Participant screening logs, (2) Intervention delivery platform data and (3) Semi structured interviews performed with participants. Qualitative data were described using inductive thematic analysis. RESULTS The tablet-based intervention was delivered to 220 patients (112 (50.9%) male, mean age 54.2 (SD 15.4) years). Of 765 videos opened, 636 (83.1%) were watched to completion. Most videos opened were rated (738/765, 96.5%) and video ratings were predominantly positive (661/738, (89.6%) satisfied or highly satisfied). Younger and more educated participants were more likely to rate videos highly (relative risk (RR) 1.73 (95% CI 1.28 to 2.32) and RR 1.26 (95% CI 1.07 to 1.49)) but less likely to watch videos to completion (younger: RR 0.27 (95% CI 0.17 to 0.43), more educated: RR 0.90 (95% CI 0.85 to 0.96)). Of 39 invited, 21 (53.8%) participated in semistructured interviews. Thematic analysis of responses suggested reported behaviour change post intervention may be due to increased awareness of cardiovascular risk, reduced anxiety and intrinsic motivation from delivery within a cardiology waiting room. Lack of reinforcement and limited personalisation were barriers. CONCLUSION The current analysis demonstrates that engagement with a digitally delivered clinic waiting room educational intervention was high, providing explanation for its efficacy in improving motivation to change cardiovascular risk behaviours. The high fidelity of delivery demonstrates potential for scaling of such interventions across waiting rooms. Recall bias and low response rate may bias self-reported engagement measures. TRIAL REGISTRATION NUMBER ANZCTR12618001725257.
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Affiliation(s)
- Daniel Mcintyre
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Jason Chiang
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Clara Kayei Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Sun Y, Tian Y, Cao S, Li L, Yu W, Ding Y, Wang X, Kong Y, Wang X, Wang H, Hui X, Qu J, Wang H, Duan Q, Yang D, Zhang H, Zhou S, Liu X, Li Z, Meng C, Kehlet H, Zhou Y. Multimodal prehabilitation to improve the clinical outcomes of frail elderly patients with gastric cancer: a study protocol for a multicentre randomised controlled trial (GISSG +2201). BMJ Open 2023; 13:e071714. [PMID: 37816552 PMCID: PMC10565164 DOI: 10.1136/bmjopen-2023-071714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/19/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Gastric cancer (GC) diagnosed in the elderly population has become a serious public health problem worldwide. Given the combined effects of frailty and the consequences of cancer treatment, older individuals with GC are more likely than young patients to suffer from postoperative complications and poor clinical outcomes. Nutrition, functional capacity and psychological state-based multimodal prehabilitation, which is dominated by Enhanced Recovery After Surgery (ERAS) pathway management, has been shown to reduce postoperative complications, promote functional recovery and decrease hospitalisation time in certain malignancies. However, no previous studies have investigated the clinical application of multimodal prehabilitation in frail older patients with GC. METHODS AND ANALYSIS The study is a prospective, multicentre randomised controlled trial in which a total of 368 participants who meet the inclusion criteria will be randomised into either a prehabilitation group or an ERAS group. The prehabilitation group will receive multimodal prehabilitation combined with ERAS at least 2 weeks before the gastrectomy is performed, including physical and respiratory training, nutritional support, and therapy and psychosocial treatment. The ERAS group patients will be treated according to the ERAS pathway. All interventions will be supervised by family members. The primary outcome measures are the incidence and severity of postoperative complications. Secondary outcomes include survival, functional capacity and other short-term postoperative outcomes. Overall, the multimodal prehabilitation protocol may improve functional capacity, reduce the surgical stress response and concomitant systemic inflammation, and potentially modulate the tumour microenvironment to improve short-term and long-term clinical outcomes and patients' quality of life. ETHICS AND DISSEMINATION All procedures and participating centres of this study were approved by their respective ethics committees (QYFYKYLL 916111920). The final study results will be published separately in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05352802.
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Affiliation(s)
- Yuqi Sun
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yulong Tian
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shougen Cao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Wenbin Yu
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yinlu Ding
- Department of Gastrointestinal Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Xixun Wang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Ying Kong
- Department of Gastrointestinal Surgery, Jining No.1 People's Hospital, Jining, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of General Surgery, Dongying People's Hospital, Dongying, China
| | - Xizeng Hui
- Department of General Surgery, Rizhao People's Hospital, Rizhao, China
| | - Jianjun Qu
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - HongBo Wang
- Department of Gastrointestinal Surgery, People's Hospital of Jimo District, Qingdao, People's Republic of China
| | - Quanhong Duan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Shaofei Zhou
- Department of Gastrointestinal Surgery, Qingdao Municipal Hospital Group, Qingdao, China
| | - Xiaodong Liu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zequn Li
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Meng
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet Copenhagen University, Denmark, UK
| | - Yanbing Zhou
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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McDonald CE, Voutier C, Govil D, D’Souza AN, Truong D, Abo S, Remedios LJ, Granger CL. Do health service waiting areas contribute to the health literacy of consumers? A scoping review. Health Promot Int 2023; 38:daad046. [PMID: 37440256 PMCID: PMC10340083 DOI: 10.1093/heapro/daad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.
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Affiliation(s)
- Cassie E McDonald
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
- Allied Health, Alfred Health, Melbourne, VIC 3004, Australia
| | - Catherine Voutier
- Health Sciences Library, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dhruv Govil
- Department of Business Intelligence and Reporting, Bass Coast Health, Wonthaggi, VIC 3995, Australia
| | - Aruska N D’Souza
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dominic Truong
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Louisa J Remedios
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Physiotherapy, Federation University, Churchill, VIC 3842, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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Hentati A, Forsell E, Ljótsson B, Lindefors N, Kraepelien M. A self-guided and monitored digital problem-solving intervention for patients with symptoms of depression or anxiety on the waiting list for treatment in routine psychiatric care: feasibility study. BJPsych Open 2022; 8:e43. [PMID: 35130998 PMCID: PMC8867893 DOI: 10.1192/bjo.2022.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is often a waiting period for people who seek psychiatric treatment for depression or anxiety. As this delay risks worsening symptoms, an alternative could be to provide an intervention that requires minimal resources during the waiting period. AIMS The aim was to investigate if a digital problem-solving intervention delivered in a self-guided format with automated features is feasible to provide for patients on the waiting list in routine psychiatric care. METHOD A total of 12 patients with symptoms of depression or anxiety on the waiting list for treatment in routine psychiatric care were given access to a self-guided and monitored digital problem-solving intervention over 4 weeks. Primary outcome measures were treatment credibility and usability. Secondary outcome measures were behavioural engagement, symptoms of depression and anxiety, and negative effects. RESULTS A majority of participants rated the intervention as both credible and usable. The intervention was used at least once by nine out of 12 individuals, with an average of 11 logins. The participants did, on average, initiate 2.8 problem-solving attempts and 10.1 solutions. A few participants reached a clinically relevant symptom improvement of depression and anxiety. No serious negative effects were reported. CONCLUSIONS The credibility and usability of the intervention was perceived as good, and the behavioural engagement with the intervention was deemed sufficient compared with similar self-guided interventions. A self-guided and monitored digital problem-solving intervention may be a beneficial option for patients waiting for or receiving treatment in routine psychiatric care, and should be further evaluated.
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Affiliation(s)
- Amira Hentati
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Erik Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Distinct trajectories of depression symptoms in early and middle adolescence: Preliminary evidence from longitudinal network analysis. J Psychiatr Res 2021; 142:198-203. [PMID: 34365068 DOI: 10.1016/j.jpsychires.2021.07.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 11/27/2022]
Abstract
Adolescent depression is a clinically relevant concern that has major implications for mental and physical health. The trajectory of depressive symptoms among adolescents suggests that there is likely variability throughout this developmental period. The aim of the study was to assess the longitudinal relationship between individual symptoms of depression among early and middle adolescents to provide guidance for future research investigating targeted intervention efforts. Data were extracted from electronic medical records (2015-2017) from a pediatric primary care clinic in an urban setting. Cross-Lagged Panel Network analysis was used to evaluate symptoms of depression measured with the Patient Health Questionnaire (PHQ-9) measured twice over a 1-year period among early adolescents (ages 11-13 years; n = 309) and middle adolescents (ages 14-16 years; n = 255). The sample was predominantly Hispanic (90%) and 56% female. The analyses highlighted key differences and similarities between early and middle adolescence, largely focused on the role of suicidal ideation and tightly linked with feelings of failure and appetitive disturbance. In early adolescence suicidal ideation was highly likely to lead to other symptoms. In middle adolescence, however, suicidal ideation no longer had connections to other symptoms and instead the strongest connections were toward suicidal ideation. Interestingly, across both early and middle adolescence feelings of failure and appetitive disturbance were highly likely to lead to suicidal ideation. These exploratory findings highlight several longitudinal associations between early and middle adolescence that provide insight into differences and similarities regarding how symptoms might progress within those developmental periods. Taken together these results can provide direction for future research to evaluate brief, targeted interventions for adolescents.
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