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Pembroke L, Sherman KA, Dhillon HM, Francis H, Gillatt D, Gurney H. Online Group Cognitive Rehabilitation Program for Prostate Cancer Survivors: Development Using Codesign and the Theoretical Domains Framework. Semin Oncol Nurs 2024:151695. [PMID: 39054190 DOI: 10.1016/j.soncn.2024.151695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This study aimed to describe the adaptation of a group cognitive rehabilitation program for prostate cancer survivors (PCS) via telehealth delivery using a codesign approach with PCS experiencing cancer-related cognitive impairment. The Theoretical Domains Framework (TDF) also informed the intervention development. METHODS Intervention development consisted of three steps: 1) Adapting an existing cancer-related cognitive rehabilitation program for PCS; 2) Conducting a codesign focus group workshop to gather feedback that was analyzed using a template approach; and 3) Incorporation of consumer feedback to refine the program for future piloting in PCS. Components of the finalized intervention were mapped onto the TDF domains. RESULTS Six PCS were involved in the codesign focus group workshop, providing feedback on program structure, the topics and its order, and rehabilitation activities. A manualized four-week online group cognitive rehabilitation program titled "Promoting Cognitive Wellbeing in Prostate Cancer Survivors (ProCog)" was developed. Four sessions of 2-hours' duration were designed exploring: cognitive/brain functions; the impact of cancer treatments and ageing; the relationship between thoughts, feelings and behaviors; values-based goal-setting; and skills/strategies to manage fatigue and improve attention, memory, aspects of executive functioning, and emotional functioning. CONCLUSIONS Consumer input and guidance from the TDF ensures a robust development process for the online ProCog intervention, designed for and with PCS experiencing cognitive difficulties. As an important initial step before piloting, this adaptation and development process ensures that ProCog addresses consumer needs and preferences and targets factors increasing behavior change. IMPLICATIONS FOR NURSING PRACTICE This research raises awareness of possible cancer-related cognitive impairments in prostate cancer survivors and strategies for rehabilitation. ProCog is an accessible online intervention that nurses can use to refer patients needing cognitive rehabilitation.
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Affiliation(s)
- Lorna Pembroke
- Lifespan Health and Wellbeing Research Centre, Macquarie University, New South Wales, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia.
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, New South Wales, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - Heather Francis
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
| | - David Gillatt
- Macquarie University Urology Clinic, Faculty of Medicine and Health Sciences, Macquarie, University & Macquarie University Hospital, New South Wales, Australia
| | - Howard Gurney
- Macquarie University Clinical Trials Unit (CTU), Faculty of Medicine and Health Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
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Platt R, Richman R, Martin C, Martin KJ, Mendelson T. Feasibility and Acceptability of a Video Group Psychoeducational Intervention with Latina Immigrant Mothers to Enhance Infant Primary care. J Immigr Minor Health 2024:10.1007/s10903-024-01612-7. [PMID: 38963477 DOI: 10.1007/s10903-024-01612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
Standard models of well-child care may not sufficiently address preventive health needs of immigrant families. To augment standard individual well-child care, we developed a virtual group-based psychoeducational intervention, designed to be delivered in Spanish as a single, stand-alone session to female caregivers of 0-6 month-olds. The intervention included a video testimonial of an individual who experienced perinatal depression followed by a facilitated discussion by the clinic social worker and an orientation to relevant community resources by a community health worker. To assess feasibility and acceptability of the intervention, we conducted an open pilot within an academic pediatric practice serving predominantly Latinx children in immigrant families. Participants included 19 female caregivers of infants attending the practice, of whom 16 completed post-intervention measures and 13 completed post-intervention semi-structured interviews. Quantitative measures of acceptability and satisfaction with the intervention were high. We found preliminary effects of the intervention on postpartum depression knowledge and stigma in the expected direction. In interviews, participants described increases in their familiarity with postpartum depression and about relevant community resources, including primary care for caregivers. Participants reported an appreciation for the opportunity to learn from other caregivers and provided suggestions for additional topics of interest. Trial registration: Registered 6/21/22 as NCT05423093.
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Centro SOL-Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rebecca Richman
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Keith J Martin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Centro SOL-Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Xu J, Falkenstein MJ, Kuckertz JM. Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD. J Affect Disord 2024; 353:19-26. [PMID: 38423365 PMCID: PMC11059676 DOI: 10.1016/j.jad.2024.02.091] [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: 10/18/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. METHODS Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. RESULTS Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. LIMITATIONS The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. CONCLUSIONS Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.
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Affiliation(s)
- Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America.
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Oakey-Frost N, Crapanzano KA, Gerner J, Cowan T, Jobes DA, Tucker RP. An observational pilot of the collaborative assessment and management of suicidality brief intervention (CAMS-BI) for adult inpatients. Gen Hosp Psychiatry 2024; 87:146-147. [PMID: 37777346 DOI: 10.1016/j.genhosppsych.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Nicolas Oakey-Frost
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
| | - Kathleen A Crapanzano
- Louisiana State University Health Sciences Center, 5246 Brittany Drive, Baton Rouge, LA 70808, USA
| | - Jessica Gerner
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Tovah Cowan
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - David A Jobes
- Catholic University of America, O'Boyle Hall, Washington, DC 20064, USA
| | - Raymond P Tucker
- Louisiana State University A&M College, 236 Audubon Hall, Baton Rouge, LA 70803, USA; Louisiana State University Health Sciences Center, 5246 Brittany Drive, Baton Rouge, LA 70808, USA
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Moullin JC, Staniland L, Uren H, Nielsen S, Lenton S. Advancing the implementation of take-home naloxone by community pharmacists: Testing the role of COM-B. Drug Alcohol Rev 2024; 43:746-759. [PMID: 38287683 DOI: 10.1111/dar.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Opioid-related overdose fatalities are rising despite the increased accessibility of take-home naloxone (THN). Targeted implementation strategies are needed to improve the distribution of naloxone. This study investigates the effectiveness of a short video targeting pharmacists that addresses implementation barriers. METHODS A pre-post, mixed methods design was adopted to examine the effect of a brief behaviour change intervention (an educational video informed by the capability, opportunity, motivation affecting behaviour (COM-B) model), on factors affecting pharmacists' implementation of THN in Western Australia. Paired samples t-tests for were used to investigate intentions, knowledge, skill, confidence, feasibility, appropriateness, acceptability, attitudes, anticipated patient reactions, social support and implementation climate. Structural equation modelling examined the associations between constructs and to test the proposed mediation of motivation on capability and opportunity affecting intentions to discuss and provide THN. RESULTS We analysed data from 102 participants. At follow-up and after all participants had viewed the video, participants had significantly improved intentions, skill, confidence, anticipated reactions, social support and perceptions that THN implementation was feasible, appropriate and acceptable. No significant differences were seen for attitudes, knowledge or implementation climate. The proposed mediation effect of motivation on the associations between opportunity and intentions and capability and intentions was not supported. DISCUSSION AND CONCLUSIONS A short video directly targeting identified implementation barriers has the ability to improve key influences in the provision of THN. Dissemination of information to community pharmacists is a challenge. Implementation strategies addressing knowledge and targeting other levels of influence on intentions and behaviour are required.
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Affiliation(s)
- Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | | | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
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Meisel SN, Boness CL, Miranda R, Witkiewitz K. Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:215-229. [PMID: 38099412 PMCID: PMC10922633 DOI: 10.1111/acer.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.
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Affiliation(s)
| | | | - Robert Miranda
- E. P. Bradley Hospital, Riverside, RI USA
- Department of Psychiatry & Human Behavior, Brown University, Providence, RI USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Park SY, Yourell J, McAlister KL, Huberty J. Exploring Generation Z and Young Millennials' Perspectives of a Spiritual Self-Care App and Their Spiritual Identity (Skylight): Qualitative Semistructured Interview Study. JMIR Form Res 2023; 7:e54284. [PMID: 38064199 PMCID: PMC10784987 DOI: 10.2196/54284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Generation Z and young millennials (ages 18-35 years), collectively referred to as GenZennials, are connected to technology and the internet like no other generation before them. This has mental health implications, such as increased rates of anxiety and stress. Recent research has shown that app-based mental health interventions can be useful to address such mental health concerns. However, spirituality is an untapped resource, especially since GenZennials largely identify as spiritual and already integrate spiritual practices into their self-care. OBJECTIVE There were four objectives to this study: (1) comprehensively explore reasons why GenZennials use a spiritual self-care app (ie, Skylight; Radiant Foundation), (2) understand how GenZennials identify spiritually, (3) understand the app's relevance to GenZennials, and (4) gather feedback and suggestions to improve the app. METHODS Semistructured interviews were conducted with 23 GenZennials (ages 18-35 years; mean 28.7, SD 5.0 years; n=20, 87% female) who used the Skylight app. Interviews were 30 to 60 minutes and conducted on Zoom. Thematic analysis was used to analyze interviews. RESULTS Five major categories emerged from the analysis, each encompassing one to several themes: (1) reasons for using the Skylight app, (2) content favorites, (3) defining spiritual identity, (4) relevance to GenZennials, and (5) overall improvement recommendations. Participants used the app for various reasons including to relax, escape, or ground themselves; improve mood; and enhance overall health and wellness. Participants also cited the app's variety of content offerings and its free accessibility as their primary reasons for using it. Most participants identified themselves as solely spiritual (8/23/35%) among the options provided (ie, spiritual or religious or both), and they appreciated the app's inclusive content. Participants felt that the app was relevant to their generation as it offered modern content (eg, spiritual self-care activities and short content). Participants recommended adding more personalization capabilities, content, and representation to the app. CONCLUSIONS This is the first study to qualitatively explore GenZennials' perspectives and the use of a spiritual self-care app. Our findings should inform the future creation and improvement of spiritual self-care apps aimed at cultivating GenZennials' spiritual and mental well-being. Future research is warranted to examine the effects of using a spiritual self-care app on GenZennial mental health.
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Affiliation(s)
- Susanna Y Park
- Skylight, Radiant Foundation, Salt Lake City, UT, United States
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Natali L, Cardi V, Lunghi M, Ferrara R, Marconi L, Bottesi G. The Acceptability of a Psychoeducation and Skill-Based Training for Carers and Teachers to Cope with Risky Behaviours in Adolescence. CHILDREN (BASEL, SWITZERLAND) 2023; 11:38. [PMID: 38255352 PMCID: PMC10814090 DOI: 10.3390/children11010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Childhood and adolescence psychopathology is associated with an increased risk of psychological difficulties in adulthood. Early interventions for youth should provide carers and teachers with knowledge and skills to respond to adolescents' risky behaviours. This study evaluated the acceptability and effectiveness of a single 3-h workshop, combining psychoeducation and skills training to promote knowledge about, and confidence to address, adolescents' risky behaviours in carers and teachers of adolescents aged 10-14. Demographics and perceived self-efficacy in the parental or teaching role were collected at baseline using self-report questionnaires. Motivation and confidence to respond to adolescents' risky behaviours were measured before and after the workshop using motivational rulers. Participants provided written feedback about their experience about the workshop. Twenty-seven carers and 27 teachers attended the workshops. Teachers reported a significant increase in both importance (p = 0.021) and confidence (p < 0.001) to respond to risky behaviours following the workshop. This change was associated with baseline self-efficacy levels (importance: p = 0.011; confidence: p = 0.002). Carers also reported greater confidence to address risky behaviours following the workshop (p = 0.002). Participants found the contents and methods of the workshop highly acceptable. Online and multiple-session workshops might increase reach and effectiveness.
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Affiliation(s)
- Ludovica Natali
- Centro di Ateneo Servizi Clinici Universitari Psicologici, University of Padova, 35131 Padova, Italy; (L.N.); (V.C.); (M.L.); (R.F.); (L.M.)
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | - Valentina Cardi
- Centro di Ateneo Servizi Clinici Universitari Psicologici, University of Padova, 35131 Padova, Italy; (L.N.); (V.C.); (M.L.); (R.F.); (L.M.)
- Department of General Psychology, University of Padova, 35131 Padova, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Marco Lunghi
- Centro di Ateneo Servizi Clinici Universitari Psicologici, University of Padova, 35131 Padova, Italy; (L.N.); (V.C.); (M.L.); (R.F.); (L.M.)
- Department of Developmental Psychology and Socialisation, University of Padova, 35131 Padova, Italy
| | - Rosanna Ferrara
- Centro di Ateneo Servizi Clinici Universitari Psicologici, University of Padova, 35131 Padova, Italy; (L.N.); (V.C.); (M.L.); (R.F.); (L.M.)
| | - Linda Marconi
- Centro di Ateneo Servizi Clinici Universitari Psicologici, University of Padova, 35131 Padova, Italy; (L.N.); (V.C.); (M.L.); (R.F.); (L.M.)
| | - Gioia Bottesi
- Centro di Ateneo Servizi Clinici Universitari Psicologici, University of Padova, 35131 Padova, Italy; (L.N.); (V.C.); (M.L.); (R.F.); (L.M.)
- Department of General Psychology, University of Padova, 35131 Padova, Italy
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Ghosh A, Cohen KA, Jans L, Busch CA, McDanal R, Yang Y, Cooper KM, Schleider JL. A Digital Single-Session Intervention (Project Engage) to Address Fear of Negative Evaluation Among College Students: Pilot Randomized Controlled Trial. JMIR Ment Health 2023; 10:e48926. [PMID: 37995114 DOI: 10.2196/48926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student's sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors. OBJECTIVE This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way. METHODS To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus. RESULTS In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of -2 to +2) and had a high completion rate (>97%). CONCLUSIONS This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class. TRIAL REGISTRATION OSF Registries osf.io/4ca68 http://osf.io/4ca68.
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Affiliation(s)
- Arka Ghosh
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Katherine A Cohen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Laura Jans
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Carly A Busch
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Riley McDanal
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Yuanyuan Yang
- Department of Psychology, University of Kansas, Lawrence, KS, United States
| | - Katelyn M Cooper
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Jessica L Schleider
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Woodfield MJ, Phillips ST, Cargo T, Merry SN, McNeil CB, Hetrick SE. Applying the Theoretical Domains Framework to Develop an Intervention to 'Re-implement' Parent-Child Interaction Therapy (PCIT). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:976-998. [PMID: 37691065 PMCID: PMC10543774 DOI: 10.1007/s10488-023-01298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for childhood conduct problems, with increasing numbers of clinicians being trained in Aotearoa/New Zealand. However, ensuring sustained delivery of effective treatments by trained clinicians in routine care environments is notoriously challenging. The aims of this qualitative study were to (1) systematically examine and prioritise PCIT implementation barriers and facilitators, and (2) develop a well specified and theory-driven 're-implementation' intervention to support already-trained clinicians to resume or increase their implementation of PCIT. To triangulate and refine existing understanding of PCIT implementation determinants from an earlier cross-sectional survey, we integrated previously unanalysed qualitative survey data (54 respondents; response rate 60%) with qualitative data from six new focus groups with 15 PCIT-trained clinicians and managers in Aotearoa/New Zealand. We deductively coded data, using a directed content analysis process and the Theoretical Domains Framework, resulting in the identification of salient theoretical domains and belief statements within these. We then used the Theory and Techniques Tool to identify behaviour change techniques, possible intervention components, and their hypothesised mechanisms of action. Eight of the 14 theoretical domains were identified as influential on PCIT-trained clinician implementation behaviour (Knowledge; Social/Professional Role and Identity; Beliefs about Capabilities; Beliefs about Consequences; Memory, Attention and Decision Processes; Environmental Context and Resources; Social Influences; Emotion). Two of these appeared to be particularly salient: (1) 'Environmental Context and Resources', specifically lacking suitable PCIT equipment, with (lack of) access to a well-equipped clinic room appearing to influence implementation behaviour in several ways. (2) 'Social/Professional Role and Identity', with beliefs relating to a perception that colleagues view time-out as harmful to children, concerns that internationally-developed PCIT is not suitable for non-Māori clinicians to deliver to Indigenous Māori families, and clinicians feeling obligated yet isolated in their advocacy for PCIT delivery. In conclusion, where initial implementation has stalled or languished, re-implementation may be possible, and makes good sense, both fiscally and practically. This study suggests that re-implementation of PCIT in Aotearoa/New Zealand may be facilitated by intervention components such as ensuring access to a colleague or co-worker who is supportive of PCIT delivery, access to suitable equipment (particularly a time-out room), and targeted additional training for clinicians relating to the safety of time-out for children. The feasibility and acceptability of these intervention components will be tested in a future clinical trial.
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Affiliation(s)
- Melanie J. Woodfield
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Te Whatu Ora (Health New Zealand), Te Toka Tumai Auckland, Auckland, New Zealand
| | | | - Tania Cargo
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Department of Psychology, University of Auckland, Auckland, New Zealand
| | - Sally N. Merry
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
| | - Cheryl B. McNeil
- Department of Psychology, West Virginia University, Morgantown, USA
- Department of Psychiatry, University of Florida, Gainesville, USA
| | - Sarah E. Hetrick
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Blackshaw E, Sefi A, Mindel C, Maher H, De Ossorno Garcia S. Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change. Psychol Psychother 2023; 96:644-661. [PMID: 36920075 DOI: 10.1111/papt.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic. AIMS This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner). MATERIALS AND METHODS The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021. RESULTS Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender. DISCUSSION AND CONCLUSION Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.
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Affiliation(s)
- Emily Blackshaw
- Department of Psychology, University of Roehampton, London, UK
- Impact and Evaluation, Coram, London, UK
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Eyllon M, Dalal M, Jans L, Sotomayor I, Peloquin G, Yon J, Fritz R, Schleider J. Referring Adolescent Primary Care Patients to Single-Session Interventions for Anxiety and Depression: Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e45666. [PMID: 37556202 PMCID: PMC10448284 DOI: 10.2196/45666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Despite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions (SSIs) for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap. OBJECTIVE We aimed to implement a clinical workflow for primary care and behavioral health providers to refer patients aged 13 to 17 years with mild to moderate depression and anxiety symptoms to Project YES (Youth Empowerment and Support), an open-access SSI platform, in a large group medical practice with an integrated behavioral health department. METHODS Pediatric primary care and integrated behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the electronic health record system, Epic, to refer patients during well-child visits and pediatric behavioral health visits. Patients with mild to moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time. RESULTS The rollout will take place between November 2022 and May 2023, when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023. CONCLUSIONS SSIs such as those available through Project YES have the potential to provide low-cost, evidence-based mental health treatment to adolescents with mild to moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45666.
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Affiliation(s)
- Mara Eyllon
- Practice Research Network, Reliant Medical Group, Worcester, MA, United States
| | - Michelle Dalal
- Northeastern University, Northeastern University Health and Counseling Services, Boston, MA, United States
- Department of Pediatrics, Chan School of Medicine, University of Massachusetts, Worcester, MA, United States
| | - Laura Jans
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Ian Sotomayor
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Gabrielle Peloquin
- Practice Research Network, Reliant Medical Group, Worcester, MA, United States
| | - James Yon
- Behavioral Health Department, Reliant Medical Group, Worcester, MA, United States
| | - Rochelle Fritz
- Behavioral Health Department, Reliant Medical Group, Worcester, MA, United States
| | - Jessica Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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Moullin JC, Ely P, Uren H, Staniland L, Nielsen S, Lenton S. Developing a single-session strategy for the implementation of take-home naloxone by community pharmacists using COM-B and design-thinking. FRONTIERS IN HEALTH SERVICES 2023; 3:1227360. [PMID: 37600924 PMCID: PMC10434522 DOI: 10.3389/frhs.2023.1227360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
Background Despite the overwhelming evidence of its effectiveness, there is poor implementation of take-home naloxone by pharmacists. Barriers have been explored and mapped to the capability, opportunity, motivation-behaviour (COM-B) model of behaviour change, yet no theoretically informed implementation strategies that target known barriers have been developed. Single-session implementation strategies have been proposed as a simple, scalable way to target multiple barriers. Methods Qualitative participatory methods, incorporating design-thinking principles, were used to develop the key messages of a single-session implementation strategy. The key messages were drafted against COM-B mapped implementation barriers identified in the literature. A participatory workshop involving a pre-mortem exercise and incorporating design-thinking principles were used to refine the messages and generate methods for dissemination. Messages were mapped to interview questions to naturally illicit stories and delivered via storytelling from a pharmacist, a general practitioner, and a person with lived experience of using naloxone. Results A 3 minute 40 second video and a two-page printable infographic were developed and hosted on a website, with links to additional downloadable resources as a single-session implementation strategy. Email was the preferred method for receiving simple professional development communications, with social media also widely accessed. Discussion Implementation science, behavioural change theory, and participatory design methods are a complementary combination to develop implementation strategies. Some pharmacists questioned the participatory design approach to developing an implementation strategy, as it was outside of their comfort zone. However, the participatory process involving end-users resulted in unique ideas that are unlikely to have been generated using more traditional consultative approaches. The delivery as a single-session implementation strategy allows for widespread dissemination and delivery at scale.
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Affiliation(s)
- Joanna C. Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- enAble Institute, Curtin University, Bentley, WA, Australia
| | - Philip Ely
- School of Design and the Built Environment, Faculty of Humanities, Curtin University, Bentley, WA, Australia
| | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Lexy Staniland
- enAble Institute, Curtin University, Bentley, WA, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, VIC, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Bentley, WA, Australia
- National Drug Research Institute, Curtin University, Bentley, WA, Australia
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Smith AC, Ahuvia I, Ito S, Schleider JL. Project Body Neutrality: Piloting a digital single-session intervention for adolescent body image and depression. Int J Eat Disord 2023; 56:1554-1569. [PMID: 37129116 PMCID: PMC10524309 DOI: 10.1002/eat.23976] [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: 01/03/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Eating disorders and depression impact youth at alarming rates, yet most adolescents do not access support. Single-session interventions (SSIs) can reach youth in need. This pilot examines the acceptability and utility of a SSI designed to help adolescents improve functionality appreciation (a component of body neutrality) by focusing on valuing one's body based on the functions it performs, regardless of appearance satisfaction. METHOD Pre- to post-intervention data were collected, and within-group effect sizes and 95% confidence intervals were computed, to evaluate the immediate effects of the SSI on hopelessness, functionality appreciation, and body dissatisfaction. Patterns of use, demographics, program feedback, and responses from within the SSI were collected. RESULTS The SSI and all questionnaires were completed by 75 adolescents (ages: 13-17 years, 74.70% White/Caucasian, 48.00% woman/girl) who reported elevated body image and mood problems. Analyses detected significant pre-post improvements in hopelessness (dav = 0.60, 95% CI: 0.35-0.84; dz = 0.77, 95% CI: 0.51-1.02), functionality appreciation (dav = 0.72, 95% CI: 0.46-0.97; dz = 0.94, 95% CI: 0.67-1.21), and body dissatisfaction (dav = 0.61, 95% CI: 0.36-0.86; dz = 0.76, 95% CI: 0.50-1.02). The SSI was rated as highly acceptable, with a mean overall score of 4.34/5 (SD = 0.54). Qualitative feedback suggested adolescents' endorsement of body neutrality concepts, including functionality appreciation, as personally-relevant, helpful targets for intervention. DISCUSSION This evaluation supports the acceptability and preliminary effectiveness of the Project Body Neutrality SSI for adolescents with body image and mood concerns. PUBLIC SIGNIFICANCE Results suggest the acceptability and utility of a digital, self-guided, single-session intervention-Project Body Neutrality-for adolescents experiencing co-occurring depressive symptoms and body image disturbances. Given the intervention's low cost and inherent scalability, it may be positioned to provide support to youth with limited access to traditional care.
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Affiliation(s)
- Arielle C Smith
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Isaac Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Sakura Ito
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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