Brief interventions to promote behavioral change in primary care settings, a review of their effectiveness for smoking, alcohol and physical inactivity

A pre-experimental design evaluation of brief harm reduction interventions to improve coping self-efficacy of carers of people with substance use disorder

BACKGROUND

Globally, the rise in the number of people living with a substance use disorder (SUD) carries a multitude of individual and social health implications for carers and their families, often impacting negatively on their quality of life. Considered from a harm reduction approach, SUD is understood as a chronic protracted, complex health and social condition. From the extant literature, there is no evidence of the harm reduction approach being applied to address the needs of carers/family members who carry the burden of SUD care. This study preliminarily evaluated the Care4Carers Programme. It is a purposively designed set of brief interventions to improve the coping self-efficacy of carers of people with SUD (PwSUD carers) by equipping them to think about ways to exert control over their motivation, behaviours and social environment.

METHODS

A pre-experimental, one group pretest-posttest design was implemented with 15 purposively selected participants in the Gauteng Province of South Africa. The intervention was conducted by the lead researcher, a registered social worker. Eight brief intervention sessions were held, over 5-6 weeks at research sites where the participants were identified. The coping self-efficacy scale was completed before and directly after exposure to the programme. Results were analysed using paired t-tests.

RESULTS

There were statistically significant (p < .05) improvements in carers' coping self-efficacy, both overall and in respect of each of its constituent components: problem-focused coping, emotion-focused coping and social support strategies.

CONCLUSIONS

The Care4Carers Programme improved the coping self-efficacy of carers of people living with SUDs. The application of this programmatic harm reduction intervention to support PwSUD carers should be tested on a larger scale across South Africa.

Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature

Background

Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS.

Methods

A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline.

Results

Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable.

Conclusions

Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.

Proactive multipurpose health risk screening in health care settings: Methods, design, and reach

OBJECTIVES

Real world implementation of proactive screening and brief intervention in health care is threatened by high cost. Using e-health interventions and screening for multiple health risk factors may provide more efficiency. We describe methodological details of a proactive multipurpose health risk screening in health care settings and report on participation rates, participants' characteristics, and participation factors.

METHODS

Patients between 18 and 64 years from ambulatory practices and hospitals were proactively approached by study assistants at three sites for a computerized screening on harmful alcohol and tobacco consumption, depressive symptoms, insufficient fruit/vegetable consumption, physical inactivity and overweight. On the basis of their health risk pattern, a computerized algorithm allocated patients to one of five studies each of them addressing a psychiatric research question.

RESULTS

Among all eligible patients, 13,763 (86.5%) were screened. Younger age and being female predicted screening participation. Of those with complete data (n = 12,828), 82.9% reported at least two health risks and 34.0% were eligible for a study. Study participation ranged between 35.2% and 50.8%, and was associated with socio-demographics and problem severity.

CONCLUSIONS

This study supports the use of systematic proactive screening for multiple health risks in health care settings as it is more resource-saving than single focused screening.