Development of a Smoke-Free Homes Intervention for Parents: An Intervention Mapping Approach

Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach

Background

Treatment guidelines for psychosis recommend offering psychotherapy already in the acute illness phase. However, there is a lack of available interventions adapted to the specific needs and key change mechanisms of inpatients experiencing severe symptoms and crisis. In this article we outline the scientific development process of a needs-oriented and mechanism-based group intervention for acute psychiatric inpatients with psychosis (MEBASp).

Methods

To guide our intervention design, we used Intervention Mapping (IM), a six-step framework for developing evidence-based health interventions that consisted of an extensive literature review, an in-depth problem definition and needs analysis, the modeling of change mechanisms and outcomes and the production of an intervention prototype.

Results

Our low-threshold modularized group intervention consists of nine stand-alone sessions (two per week) within three modules and targets different aspects of metacognitive and social change mechanisms. Module I and II aim to reduce acute symptoms by fostering cognitive insight, Module III focuses on reducing distress via cognitive defusion. Therapy contents are adapted from existing metacognitive treatments such as the Metacognitive Training and presented in a destigmatizing, simply understandable and experience-oriented way.

Conclusion

MEBASp is currently evaluated in a single-arm feasibility trial. Using a systematic and rigorous development methodology and providing a detailed description of the development steps demonstrated to be invaluable in improving the intervention's scientific foundation, validity, and replicability for similar research.

Measuring secondhand smoke in homes in Malaysia: A feasibility study comparing indoor fine particulate (PM_2.5) concentrations following an educational feedback intervention to create smoke-free homes during the COVID-19 pandemic

INTRODUCTION

Extensive regulations have been introduced to reduce secondhand smoke (SHS) exposure among non-smokers in Malaysia. However, there is still a need to encourage behavior change of smokers in relation to making homes smoke-free. This feasibility study aimed to use low-cost air pollution monitors to quantify SHS concentrations in Malaysian households and to explore the practicality of using personalized feedback in educating families to make their homes smoke-free.

METHODS

A total of 35 smokers in three states in Malaysia were recruited via snowball and convenience sampling methods. Indoor fine particulate (PM_2.5) concentrations in participants’ homes were measured for 7 days before and after educational intervention using a pre-defined template, which included personalized air-quality feedback, and information on SHS impacts were given. The feedback was delivered over two 20-minute phone calls or in-person sessions following the completion of the air-quality measurements. Data were corrected for outdoor PM_2.5 concentrations from the nearest environmental monitor.

RESULTS

Despite the challenges in conducting the project during COVID-19 pandemic, the delivery of the intervention was found to be feasible. Twenty-seven (77%) out of 35 participants completed PM_2.5 measurements and received a complete intervention. The median (IQR: 25th –75th percentile concentrations) SHS-PM_2.5 concentrations at baseline and follow-up were 18.3 µg/m³ (IQR: 13.3–28.3) and 16.2 µg/m³ (IQR: 10.4 – 25.6), respectively. There was a reduction of SHS-PM_2.5 concentrations at follow-up measurement in the houses of 17 participants (63%). The change in corrected indoor PM_2.5 concentrations between baseline and follow-up was not statistically significant (Z= -1.01, p=0.29).

CONCLUSIONS

This educational intervention, combining the use of a low-cost air particle counter with personalized air-quality feedback, was found to be feasible in the Malaysian setting. It has potential to trigger behavior change among smokers, reducing indoor smoking and consequent SHS concentrations, and increasing smoke-free home implementation. A large-scale trial is needed.

What Helps and What Hinders the Creation of a Smoke-free Home: A Qualitative Study of Fathers in Scotland

INTRODUCTION

Few studies have explored fathers' views and experiences of creating a smoke-free home, with interventions largely targeting mothers. This study aimed to identify barriers and facilitators to fathers creating a smoke-free home, to inform future intervention development.

METHODS

Eighteen fathers who were smokers and lived in Scotland were recruited from Dads' community groups, Early Years Centres and through social media advertising. Semi-structured interviews explored their views and experiences of creating a smoke-free home. A theory-informed thematic analysis using the COM-B model highlighted ways in which capability, opportunity, and motivations shaped fathers' home smoking behaviors.

RESULTS

Several fathers understood the health risks of second-hand smoke exposure through public health messaging associated with recent smoke-free legislation prohibiting smoking in cars carrying children. Limited understanding of effective exposure reduction strategies and personal mental health challenges reduced some fathers' ability to create a smoke-free home. Fathers were keen to maintain their smoke-free home rules, and their motivations for this largely centered on their perceived role as protector of their children, and their desire to be a good role model.

CONCLUSIONS

Fathers' abilities to create a smoke-free home are shaped by a range of capabilities, opportunities, and motivations, some of which relate to their role as a father. Establishing a fuller understanding of the contextual and gender-specific factors that shape fathers' views on smoking in the home will facilitate the development of interventions and initiatives that fathers can identify and engage with, for the broader benefit of families and to improve gender equity and health.

IMPLICATIONS

Our findings can inform future development of father-centered and household-level smoke-free home interventions. They identify fathers' views and experiences and help reframe smoking in the home as a gendered family-wide issue, which is important in building consensus on how best to support parents to create a smoke-free home. Our findings highlight the need for additional research to develop understanding of the ways in which gender-related aspects of family structures, heterosexual relationships, and child living arrangements influence home smoking rules and how to tailor interventions accordingly.