Added value of video edutainment on android handsets in home visits to improve maternal and child health in Bauchi State, Nigeria: Secondary analysis from a cluster randomised controlled trial

Objective

A trial of evidence-based health promotion home visits to pregnant women and their spouses in northern Nigeria found significant improvements in maternal and child health outcomes. This study tested the added value for these outcomes of including video edutainment in the visits.

Methods

In total, 19,718 households in three randomly allocated intervention wards (administrative areas) received home visits including short videos on android handsets to spark discussion about local risk factors for maternal and child health; 16,751 households in three control wards received visits with only verbal discussion about risk factors. We compared outcomes between wards with and without videos in the visits, calculating the odds ratio (OR) and 95% confidence interval (95%CI) of differences, in bivariate and then multivariate analysis adjusting for socio-economic differences between the video and non-video wards.

Results

Pregnant women from video wards were more likely than those from non-video wards to have discussed pregnancy and childbirth often with their husbands (OR 2.22, 95%CI 1.07-4.59). Male spouses in video wards were more likely to know to give more fluids and continued feeding to a child with diarrhoea (OR 1.61, 95%CI 1.21-2.13). For most outcomes there was no significant difference between video and non-video wards. The home visitors who shared videos considered they helped pregnant women and their spouses to appreciate the information about risk factors.

Conclusion

The lack of added value of the videos in the context of a research study may reflect the intensive training of home visitors and the effective evidence-based discussions included in all the visits. Further research could rollout routine home visits with and without videos and test the impact of video edutainment added to home visits carried out in a routine service context.

Ensuring treatment fidelity in intervention studies: Developing a checklist and scoring system within a behaviour change paradigm

BACKGROUND

Treatment fidelity refers to the degree to which an intervention is implemented as intended. Promoting treatment fidelity is important to achieve a valid comparison in intervention research. However, it is often underreported: few studies detail the use and development of fidelity measures. This study aims to promote the treatment fidelity of a modified version of the Derbyshire Language Scheme (M-DLS), a manualised intervention for children with language difficulties, by exploring participants' opinions on training and intervention delivery. Results inform development of a checklist and scoring system to monitor and promote treatment fidelity in a comparison trial.

METHOD

Ten student speech and language therapists (SLTs) and two research assistants (RAs) participated in the study. All received training on the M-DLS, and 10 were video-recorded completing role-plays of an M-DLS session in small groups. Feedback was gathered after training and role-plays in focus groups and interviews. Feedback was interpreted using the constructs of the Theoretical Domains Framework (TDF). A treatment fidelity checklist was then developed using the feedback. The first author and two RAs rated role-play videos using the checklist to trial it to inform amendments and to promote interrater reliability. Interrater agreement was calculated using Spearman's test of correlation.

RESULTS

Participants discussed the importance of having clear materials and time to practise sessions. They suggested amendments to the materials and training to promote treatment fidelity. The checklist and scoring system accounted for participants' suggestions, with amendments detailed in a log. Spearman's correlation results suggested agreement between the raters was strong.

CONCLUSIONS

Results emphasise the importance of training quality, practice and reflective opportunities and clear materials to promote treatment fidelity. The construction of the checklist and scoring system was described in detail, informing the development of future checklists. After further trialling, the checklist can be used to ensure the M-DLS is delivered with high treatment fidelity in the comparison trial.

WHAT THIS PAPER ADDS

What is already known on this subject Treatment fidelity is an essential component of intervention effectiveness and efficacy studies, ensuring the intervention is delivered as intended. It is also an essential component of evidence-based clinical practice. However, few research studies report the treatment fidelity process or publish the checklists used, depriving clinicians of useful information for implementation. What this study adds This study describes in detail the iterative process of treatment fidelity checklist development, engaging those implementing the intervention in development. This ensured clarity and interrater reliability of the checklist. Furthermore, a novel scoring system was developed so that accuracy of implementation can be easily compared across users and across practice attempts. What are the clinical implications of this work? The importance of treatment fidelity when implementing effective and efficacious interventions cannot be overstated. The treatment fidelity checklist developed for research can be easily adopted to support accurate implementation in clinical practice through an audit process.

Culturally adapting an evidence-based intervention to promote a healthy diet and lifestyle for Yup'ik Alaska native communities

Underserved populations are at increased risk for obesity and related cardiovascular disease, type 2 diabetes, and other chronic diseases. Lack of access to healthy foods, sedentary behaviour, and other social environmental factors contribute to disease risk. Yup'ik Alaska Native communities are experiencing lifestyle changes that are likely to affect their cardiometabolic risks. Barrera & Castro's Cultural Adaptation Framework was used to adapt an evidence-based intervention (EBI) originally designed for Latino communities for use in Yup'ik communities. Focus groups and key informant interviews were held in two Yup'ik communities. Major themes included causes of obesity, barriers and facilitators to healthy foods and physical activity, and intervention ideas. The adaptation process was guided by a Community Planning Group of Yup'ik women and included information gathering, preliminary adaptation design, preliminary adaptation tests, and adaptation refinement. Two of the adapted educational modules were pilot tested. Involving community members as co-researchers in cultural adaptation is vital for an EBI to be effective in another population. Small group gatherings led by local lay health workers are culturally appropriate and may be an effective health promotion model in Yup'ik communities. Social environmental factors affecting healthy food availability and physical activity need further exploration.

Feasibility of using the Cognitive Orientation to daily Occupational Performance in a population of Danish stroke survivors: Adaptation and study protocol

BACKGROUND

A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes.

AIM

To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility.

MATERIAL AND METHODS

The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study.

RESULTS

Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen.

CONCLUSIONS AND SIGNIFICANCE

The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.

Effectiveness and methods of cryotherapy in reducing swelling after total knee arthroplasty: A systematic review on randomized controlled trials

AIM

This study aims to investigate the effect and methods of cryotherapy in reducing swelling after total knee arthroplasty.

DESIGN

Systematic review.

METHODS

We searched PubMed, Embase, CINAHL, Cochrane Library, KoreaMed, KERIS and National Science Digital Library for randomized controlled trials on 19 August 2021. This systematic review was conducted according to the PRISMA 2009 checklist.

RESULTS

A total of eight randomized controlled trials were systematically reviewed to determine the effect and methods of cryotherapy on reducing postoperative swelling. The effects were not significantly different in six studies. Application time per cryotherapy session was 10-20 min when using an ice pack and up to 48 h when using an automated device. The duration ranged from 2 days to 1 week or until discharge, and the frequency varied from 2 to 72 times per day.

A special section: Recruiting and retaining couples from underrepresented backgrounds in intervention research

This special section represents a collection of papers on recruitment and retention of couples from underrepresented backgrounds in couple intervention research. Research shows that couples from underrepresented backgrounds tend to be missing from intervention research. This gap is concerning; conclusions about the effectiveness of these interventions are not being drawn from diverse and representative samples and it may be that scholars are inadvertently creating inappropriate and inaccessible services for these couples. Recruiting and retaining these couples require specialized efforts and attention. In this summary paper, we describe (a) the origins of this special section, (b) the existing research on recruitment and retention in couple intervention research, (c) an overview of the papers in this special section, and (d) future recommendations and directions for this aspect of methodology in couple research. This collection of papers elevates the need to involve community members from the beginning, reduce barriers to access, and create recruitment materials and a service delivery environment that is specific for the target population.

The moderating effects of school resources on the impact of a school-based intervention on the social information-processing skills of third graders in rural China

Using a school-based intervention, Let's Be Friends (LBF), designed to promote the social information-processing (SIP) skills of third-grade children in rural China, the specific aim of this study was to assess the moderating effects of school characteristics on program outcomes. We systematically tested the moderating effects of six school-resource variables (i.e., student-teacher ratio, school size, number of library books per student, number of computers per 100 students, percentage of teachers with middle- and high-level titles, and percentage of teachers with high-level title or "backbone" recognition) on outcomes in a controlled trial of LBF program. School resources (i.e., small school size, low student-teacher ratio, and more teachers with high-level title or backbone) were associated with SIP skill acquisition, reduced aggressive behavior, and higher cognitive concentration. School contextual characteristics condition the impact of social-emotional education programs in Chinese rural primary schools.

Feasibility of recruiting in prisons during a randomized controlled trial with people with serious mental illness

BACKGROUND

Successful participant recruitment is vital to the feasibly of intervention research. In the behavioral and social sciences, intervention researchers face a myriad of recruitment barriers, many of which stem from working in real-world settings and among hard-to-access populations. Optimizing recruitment efforts requires being intentional about study planning and resource allocation, carefully documenting the outcomes of recruitment efforts, and developing and implementing procedures and strategies to overcome anticipated recruitment barriers.

METHODS

The current article presents recruitment flowcharts to illustrate (a) the multistep recruitment process and (b) the points of potential participant attrition during recruitment from a two-phase group-based intervention study conducted among individuals with serious mental illness incarcerated in a state prison system in the U.S. In addition, qualitative methods are used to examine strategies employed during the study to support recruitment efforts.

RESULTS

Despite challenges, this study was able to achieve recruitment goals. Analyses found the majority of potential participant attrition occurred prior to informed consent, highlighting the need for studies to track recruitment efforts in more detail than is currently recommended by commonly used guidelines. Strategies to optimize recruitment efforts included maximizing recruiter availability, developing a responsive communication approach, demonstrating respect for facility procedures and operations, and ensuring peak preparedness.

CONCLUSION

Careful documentation of recruitment efforts and the early deployment of recruitment strategies is vital to the feasibility of intervention studies conducted in real-world settings with hard-to-access populations. The publication of recruitment procedures and outcomes can help future researchers anticipate recruitment challenges and inform recruitment goals, timelines, and strategies.

Alternative metrics for characterizing longer-term clinical outcomes in difficult-to-treat depression: I. Association with change in quality of life

BACKGROUND

In difficult-to-treat depression (DTD) the outcome metrics historically used to evaluate treatment effectiveness may be suboptimal. Metrics based on remission status and on single end-point (SEP) assessment may be problematic given infrequent symptom remission, temporal instability, and poor durability of benefit in DTD.

METHODS

Self-report and clinician assessment of depression symptom severity were regularly obtained over a 2-year period in a chronic and highly treatment-resistant registry sample (N = 406) receiving treatment as usual, with or without vagus nerve stimulation. Twenty alternative metrics for characterizing symptomatic improvement were evaluated, contrasting SEP metrics with integrative (INT) metrics that aggregated information over time. Metrics were compared in effect size and discriminating power when contrasting groups that did (N = 153) and did not (N = 253) achieve a threshold level of improvement in end-point quality-of-life (QoL) scores, and in their association with continuous QoL scores.

RESULTS

Metrics based on remission status had smaller effect size and poorer discrimination of the binary QoL outcome and weaker associations with the continuous end-point QoL scores than metrics based on partial response or response. The metrics with the strongest performance characteristics were the SEP measure of percentage change in symptom severity and the INT metric quantifying the proportion of the observation period in partial response or better. Both metrics contributed independent variance when predicting end-point QoL scores.

CONCLUSIONS

Revision is needed in the metrics used to quantify symptomatic change in DTD with consideration of INT time-based measures as primary or secondary outcomes. Metrics based on remission status may not be useful.

Effective Chronic Disease Interventions in Nursing Homes: A Scoping Review Based on the Knowledge-to-Action Framework

Objectives: The purpose of this scoping review was two-fold: 1) to identify effective intervention studies addressing chronic disease for seniors living in nursing homes (e.x. chronic heart failure, diabetes, dementia, etc.), and 2) to describe how consistently the studies' reported their stages of the Knowledge-to-Action framework (2006).Methods: This scoping review involved a systematic search of CINAHL, EMBASE, PubMed and Scopus of intervention studies, published in English and French between 1997 and 2018, that focused on the development, implementation and/or evaluation of a chronic disease management guideline or best practice for older adults 65+ residing within a nursing home (NH). Authors abstracted information specific to the seven stages of the Knowledge-to-Action framework (identifying problem, tailoring to local context, barriers and facilitators to intervention delivery, implementation, monitoring, outcome criteria, and sustainability).Results: Six studies met the inclusion criteria. Procedures for monitoring knowledge use and outcome evaluation were thoroughly described. Other stages of the Knowledge-to-Action framework were not consistently reported, including problem identification related to older adults' needs and within the context of NHs, intervention implementation, evaluation, and sustainability. Of the six studies included, only two met all the pre-defined evaluation outcomes.Conclusions: Given the need for chronic disease management in NHs, researchers are encouraged to report on intervention studies using the Knowledge-to-Action framework to optimize the likelihood that interventions will be suitable for the context of their delivery and introduce sustainable change.Clinical implications: To answer what interventions should be introduced to residents in long-term care, research must clearly demonstrate efficacy, provide enough detail for methods to be reproducible in applied contexts, and consider strategies for sustainability and the holistic needs of residents.

EBP education and skills building for leaders: An RCT to promote EBP infrastructure, process and implementation in a comprehensive cancer center

BACKGROUND

Implementation of evidence-based practice (EBP) in healthcare remains challenging. The influence of leadership has been recognized. However, few randomized trials have tested effects of an educational and skills building intervention for leaders in clinical settings.

AIMS

Test effects of an EBP leadership immersion intervention on EBP attributes over time among two cohorts of leaders at a national comprehensive cancer center.

METHODS

A stratified, randomized, wait-list group, controlled design was conducted. Participants received the evidence-based intervention one year apart (2020, n = 36; 2021, n = 30) with EBP knowledge, beliefs, competencies, implementation self-efficacy, implementation behaviors, and organizational readiness measured at pre- and post-intervention, and one- and two-year follow-ups. Participants applied learnings to a specific clinical or organization priority topic.

RESULTS

Baseline outcomes variables and demographics did not differ between cohorts except for age and years of experience. Both cohorts demonstrated significant changes in EBP attributes (except organizational readiness) post-intervention. Mixed linear modeling revealed group by time effects at 3-months for all EBP attributes except implementation behaviors and organizational readiness after the first intervention, favoring cohort 2020, with retained effects for EBP beliefs and competencies at one year. Following Cohort 2021 intervention, at 12-weeks post-intervention, implementation behaviors were significantly higher for cohort 2021.

LINKING EVIDENCE TO ACTION

An intensive EBP intervention can increase healthcare leaders' EBP knowledge and competencies. Aligning EBP projects with organizational priorities is strategic. Follow-up with participants to retain motivation, knowledge and competencies is essential. Future research must demonstrate effects on clinical outcomes.

Digital Media for Behavior Change: Review of an Emerging Field of Study

Digital media are omnipresent in modern life, but the science on the impact of digital media on behavior is still in its infancy. There is an emerging evidence base of how to use digital media for behavior change. Strategies to change behavior implemented using digital technology have included a variety of platforms and program strategies, all of which are potentially more effective with increased frequency, intensity, interactivity, and feedback. It is critical to accelerate the pace of research on digital platforms, including social media, to understand and address its effects on human behavior. The purpose of the current paper is to provide an overview and describe methods in this emerging field, present use cases, describe a future agenda, and raise central questions to be addressed in future digital health research for behavior change. Digital media for behavior change employs three main methods: (1) digital media interventions, (2) formative research using digital media, and (3) digital media used to conduct evaluations. We examine use cases across several content areas including healthy weight management, tobacco control, and vaccination uptake, to describe and illustrate the methods and potential impact of this emerging field of study. In the discussion, we note that digital media interventions need to explore the full range of functionality of digital devices and their near-constant role in personal self-management and day-to-day living to maximize opportunities for behavior change. Future experimental research should rigorously examine the effects of variable levels of engagement with, and frequency and intensity of exposure to, multiple forms of digital media for behavior change.

The Scale of Body Connection: A Multisample Study to Examine Sensitivity to Change Among Mind-Body and Bodywork Interventions

Purpose: The purpose of this measurement study was to examine the Scale of Body Connection (SBC) sensitivity to change among mind-body or bodywork interventions and to explore the concurrent validity in relation to emotion dysregulation and mindfulness skills. Methods: This study was based on multiple clinical trials that had used the SBC to evaluate changes in body awareness (BA) and bodily dissociation (BD) in response to a mind-body or bodywork intervention. To test for sensitivity to change, t tests were used to examine change and estimate effect sizes. To explore convergent validity, Pearson's product-moment correlations between the SBC subscales and Five-Facet Mindfulness Questionnaire (FFMQ) and Difficulties in Emotion Regulation Scale (DERS) were calculated among a subset of the studies, which also included these measures. Results: The BA and BD scales consistently detected significant positive responses to a range of intervention types (yoga, mindfulness meditation, BA, multimodal therapy, and bodywork), demonstrating SBC sensitivity to change. With a few exceptions, the effect sizes across studies for BA were above 0.35, indicating near moderate-to-large effect sizes. The effect sizes for BD, as a measure of responsiveness, were much smaller than for BA; however, four of the studies had effect sizes between 0.54 and 0.86. Concurrent validity with the DERS was supported by moderate-to-large correlations, and with the FFMQ, it was significant with the BA scale in one included study. Conclusions: The results of this study further establish SBC validity and sensitivity to change across a range of mind-body therapies and confirm prior findings of moderate-to-strong internal consistency reliability. The findings support the use of this brief scale to assess key dimensions of BA and BD in practice and research.

Design of a Participatory Organizational-Level Work Stress Prevention Approach in Primary Education

Background

Work stress is a serious problem in primary education. Decades of research underline the importance of participatory, organizational-level work stress prevention approaches. In this approach, measures are planned to tackle causes of work stress in a participatory manner and implemented by a working group consisting of members of the organization. This approach can only be effective if the measures contain effective ingredients to decrease work stress risks and are successfully implemented. The aim of this paper is to present an outline of a work stress prevention approach that is evaluated in primary education. To ensure the appropriateness of measures, a logic model of change is built as part of the risk assessment to facilitate the selection of appropriate measures. Progression on target behaviors as well as implementation factors are real-time monitored during implementation and fed back to the working groups, to provide the opportunity to adjust action plans when needed to optimize implementation.

Methods

The approach consists of five steps: (1) preparation: installing an advisory board and working groups, (2) risk assessment: inventory of work stress risks (questionnaires and focus groups). In addition, a behavioral analysis is performed to build a logic model of change to facilitate selection of measures, (3) action planning: conducting an action plan with appropriate measures (focus groups), (4) implementation: implementing the action plan. During implementation progression on target behaviors and implementation factors are monthly monitored and fed back to the working groups, and (5) evaluation: effects of the approach are studied in a controlled trial with measurements at baseline (T0), 1 year (T1), and 2 years (T2) follow-up. A process evaluation is carried out using quantitative (questionnaires and real-time monitoring data) and qualitative (interviews and data logs) data to study the implementation process of all steps of the work stress approach.

Discussion

We believe that building a logic model of change and real-time monitoring of implementation could be of added value to improve the success of the work stress prevention approach. With this study, we aim to provide more insights into work stress intervention research, especially in primary education.

Clinical Trial Registration

The study is registered in Netherlands Trial Register (ClinicalTrials.gov #NL9797, October 18, 2021).

Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials

BACKGROUND

Pressure injury (PI) is a significant health problem among inpatients that affects their health, quality of life, and expenses.

AIM

This systematic review aimed to compare effects of alternating pressure air mattresses (APMs) with other types of supporting surfaces as a tool for PI prevention.

METHODS

The literature published between 2009 and 2020 was searched using the databases PubMed, EMBASE, CINAHL, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses process was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane Risk of Bias Tool (RoB 2.0).

RESULTS

A total of six randomized controlled trials (RCTs) were analyzed. The incidence of hospital-acquired PIs at stage 1 or higher was reported in the APM group from 0.3% to 25%. In one study, APMs were found to be less effective than static air mattresses (SAMs); in contrast, two studies found no difference. In one study, the APM was reported to be more effective than the viscoelastic foam mattress (VFM). On the contrary, in a more recent study, the APM was reported to be less effective than the VFM, and there was no difference compared with high-specification foam mattresses in another study. Using the RoB 2.0 tool, one study was evaluated at "low risk of bias," another as "some concern," and four as "high risk."

LINKING EVIDENCE TO ACTION

There is insufficient evidence to suggest that APM is more effective in preventing PIs than other supporting surfaces. Evidence to date suggests that APM can be used in patients at risk for PIs. It is important to change position regardless of the type of support surface used. Highly controlled RCTs with low risk of bias are needed to provide strong evidence for identifying the most effective PI prevention support surfaces.

Implementing Remote Developmental Research: A Case Study of a Randomized Controlled Trial Language Intervention During COVID-19

Intervention studies with developmental samples are difficult to implement, in particular when targeting demographically diverse communities. Online studies have the potential to examine the efficacy of highly scalable interventions aimed at enhancing development, and to address some of the barriers faced by underrepresented communities for participating in developmental research. During the COVID-19 pandemic, we executed a fully remote randomized controlled trial (RCT) language intervention with third and fourth grade students (N = 255; age range 8.19-10.72 years, mean = 9.41, SD = 0.52) from diverse backgrounds across the United States. Using this as a case study, we discuss both challenges and solutions to conducting an intensive online intervention through the various phases of the study, including recruitment, data collection, and fidelity of intervention implementation. We provide comprehensive suggestions and takeaways, and conclude by summarizing some important tradeoffs for researchers interested in carrying out such studies.

Conceptualizing Suicide Prevention in Firefighters Through the lens of the Interpersonal-Psychological Theory of Suicide: A Narrative Review

Suicide is the 10th leading cause of death in the United States and is a significant public health problem. Suicide has also become a major concern among career American firefighters with rates for suicidal ideation and attempts in firefighters two to three times higher than rates in the general population. Firefighter suicide and mental health are major issues facing fire service leaders, mental health professionals, and most recently suicide experts. Despite an increased focus on understanding suicide in the fire service, there is little empirical evidence on the effectiveness of prevention in this population. The juxtaposition of elevated suicide rates with a dearth of empirical prevention data specific to firefighters warrants new approaches and conceptualizations of suicide prevention in this population. Grounded in the framework of the interpersonal-psychological theory of suicide (IPTS), this narrative review integrates select relevant firefighter specific suicide risk/protective factors and multi-level intervention/prevention literature to provide a structured approach to identifying current suicide intervention/prevention efforts with promising transportability to firefighters. Several recommendations for future intervention research specific to firefighters are also proposed.

Advancing and translating knowledge: a systematic inquiry into the 2010-2020 mental health and psychosocial support intervention research evidence base

BACKGROUND AND STUDY OBJECTIVES

MHPSS is increasingly seen as a critical component to effective and responsible humanitarian programming. This review examines the extent to which MHPSS research generated since 2010 has contributed to the public health evidence base and how this has influenced and impacted programming and policy in humanitarian settings.

METHODS

This mixed-method study included a scoping literature review (n = 50) and a consultation process with qualitative key informant interviews (n = 19) and online survey responses (n = 52) to identify the facilitating and inhibiting factors for the two areas of inquiry and to understand the broader context in which knowledge is generated and taken up. The interviews were thematically analysed and the survey responses were descriptively analysed.

RESULTS

The review identified a rapidly growing evidence base that has evaluated a range of MHPSS interventions. However, few studies examined long-term impacts of interventions, there was limited direct evidence on outcomes for children and adolescents and whole family approaches, and there were minimal replications of the same approach that could test efficacy across settings and population groups. A general shift was identified in the consultation process away from a focus on disorder towards the more positive aspects of wellbeing. However, there remained a mismatch in many studies included in the literature review, whereby the interventions were broad, community-based but the outcome measures used still focused on changes in symptoms of mental disorders.

CONCLUSION

The evidence base for MHPSS has grown significantly over the last 10 years. However, several knowledge gaps remain, as does the divide between research and practice. Moving forward, MHPSS intervention research needs to be more responsive to the needs on the ground.

Domestic Violence Interventions in Social and Health Care Settings: Challenges of Temporary Projects and Short-Term Solutions

Social welfare service and health care providers are in a key position to implement successful domestic violence (DV) interventions. However, it is known that DV intervention and prevention work is often lacking in coordination and continuity. In addition, the limited resources, hectic work pace, and changing practices negatively affect the development of successful ways to prevent and intervene in DV. This qualitative study involving 11 focus groups, composed of social welfare and health care professionals (n = 51) in a midsized Finnish hospital, examined the challenges and possibilities within DV interventions and the adoption of good practices produced by a DV intervention development project funded by the European Union (EU). The results show that short-term development projects, amid the pressure of limited time and resources, encounter serious challenges when applied to wicked and ignored problems, such as DV. Developing successful violence intervention practices requires a broad understanding of the challenges that rapid development projects present to professionals and social welfare service and health care practices at the organizational level. Hence, the implementation of good practices requires continuity in managerial and organizational support, distribution of information, documentation of DV, awareness raising, education, training, and agreement on basic tasks and responsibilities. Otherwise, the failure to continue development work derails the results of such work, and short project durations lead to unnecessary work and the need to reinvent temporary work practices time and again. Short-term interventions provide inefficient solutions to the problem of DV, and a built-in organizational structure can prevent the misuse of organizational and human resources.

Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study

Background

Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases.

Objective

This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities.

Methods

Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns.

Results

Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days).

Conclusions

This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research.

Using the Intervention Mapping Approach to Develop a Mental Health Intervention: A Case Study on Improving the Reporting Standards for Developing Psychological Interventions

Replicating or distilling information from psychological interventions reported in the scientific literature is hindered by inadequate reporting, despite the existence of various methodologies to guide study reporting and intervention development. This article provides an in-depth explanation of the scientific development process for a mental health intervention, and by doing so illustrates how intervention development methodologies can be used to improve development reporting standards of interventions. Intervention development was guided by the Intervention Mapping approach and the Theoretical Domains Framework. It relied on an extensive literature review, input from a multi-disciplinary group of stakeholders and the learnings from projects on similar psychological interventions. The developed programme, called the “Be Well Plan”, focuses on self-exploration to determine key motivators, resources and challenges to improve mental health outcomes. The programme contains an online assessment to build awareness about one’s mental health status. In combination with the exploration of different evidence-based mental health activities from various therapeutic backgrounds, the programme teaches individuals to create a personalised mental health and wellbeing plan. The use of best-practice intervention development frameworks and evidence-based behavioural change techniques aims to ensure optimal intervention impact, while reporting on the development process provides researchers and other stakeholders with an ability to scientifically interrogate and replicate similar psychological interventions.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study

Background

Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.

Objective

The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.

Methods

This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.

Results

This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.

Conclusions

The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.

International Registered Report Identifier (IRRID)

DERR1-10.2196/30899

Implementation Fidelity in the Replication of Tuning in to Teens (TINT) Adapted for Adoptive Parents and Guardians in the US

Purpose: Clear explication of the conditions necessary to reproduce results is imperative in the development of evidence-based interventions.Methods: This study used a fidelity framework to guide the exploration of implementation fidelity in a study of the Tuning in to Teens (TINT) intervention in New Jersey. TINT is an evidence-based prevention program - previously tested with parents of pre-adolescents to reduce emotionally dismissive parenting - that was adapted for use with adoptive and guardianship families.Results: The review of intervention design adaptation and protocols; intervention training; and monitoring of intervention delivery revealed extensive efforts by an adoption clinician, the purveyor of the program, and an implementation team to support the implementation efforts. Results of the monitoring of intervention receipt indicate that the intervention was implemented with high fidelity.Discussion: Future intervention research should consider assessing the effects of implementation efforts on outcomes to improve replication under real-world conditions. Regardless, this exploration of fidelity has implications for public and private organizations seeking to implement an evidence-based intervention. The framework developed by Gearing and Colleagues and the TIDieR checklist could provide useful guidance when planning for and reporting on implementation fidelity in the furtherance of developing and disseminating evidence-based interventions.

Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial

The objective of this multicenter randomized controlled trial was to evaluate the feasibility and effectiveness of a physical activity intervention for institutionalized people with dementia, individualized by capacity and biography. The intervention group (n = 34; age: mean = 86.09 years; 79.40% female; mean Mini-Mental State Examination value = 18.59) participated in a multicomponent training program, which included daily activities, dancing, gardening, and sports/games, twice weekly for 3 months. The control group (n = 29; age: mean = 86.34 years; 75.90% female; mean Mini-Mental State Examination value = 19.90) received standard care. Feasibility was evaluated by means of focus groups and feedback questionnaires. Functional performance (Short Physical Performance Battery and Timed Up and Go Test), activities of daily living, and gait were outcomes for effectiveness. A high adherence rate (80.46%) and uniformly positive feedback indicate that the piloted training program is feasible. The results show preliminary effectiveness on functional performance (Short Physical Performance Battery mean t0 = 3.15; mean t1 = 4.50; p = .006) and gait (e.g., velocity mean t0 = 46.97; mean t1 = 58.04; p = .007).

Evidence-Based Competency Training Program for Blood Product Administration

BACKGROUND

Health care in deployed military environments requires robust clinical nursing skills to care for patients with traumatic injuries. Blood product administration is a critical skill in which nurses should be competent. However, in non-deployed environments, blood transfusions are performed less frequently, resulting in skill competency loss.

AIMS

Our clinical inquiry focused on maintaining competency for infrequently performed nursing skills, specifically blood product administration.

METHODS

A literature review and critical appraisal were executed, followed by an evidence-based practice change. A knowledge test, objective and subjective assessment, and training satisfaction evaluation were performed to measure the practice change outcomes. Both inpatient and outpatient nurses were included.

RESULTS

Sixteen articles were identified and appraised. The evidence recommended a blended education approach, that is, lecture plus hands-on practice. Thus, a classroom lecture and simulation scenario were put into practice with an existing computer-based training for blood administration. The nurses met knowledge test standards (≥ 90%) before and after implementation, while skill performance improved by 13% and improved self-competence scores by 7%. Nurses in outpatient settings improved performance scores by 18.4% compared to inpatient nurses, whose scores improved by 9.4%. The simulation scenario completion time decreased by 8.3 minutes post-implementation, and the training program earned a 90% satisfactory rating.

LINKING EVIDENCE TO ACTION

A blended education program improves clinical skill performance and enhances confidence in performing critical interventions. Blended education provides a safe learning environment for nurses to be prepared for the management of low-volume patient care emergencies.

"From Analog to Digital": The Feasibility, Acceptability, and Preliminary Outcomes of a Positive Parenting Program for Street-Connected Mothers in Kenya

BACKGROUND

Children of street-connected women in Kenya are at risk of child maltreatment. There have been increasing calls for positive parenting programs for parents experiencing homelessness, however never has one been implemented with this population. We therefore adapted the evidence-based Parenting for Lifelong Health for Young Children program using participatory methods, and piloted the adapted program with street-connected mothers in Kenya.

OBJECTIVES

To (a) determine if the adapted program was feasible and acceptable with street-connected mothers, and (b) assess indicative effects on child maltreatment, positive parenting, and parental stress.

PARTICIPANTS AND SETTING

Two groups of 15 mothers (ages 19+, and 20- ) participated between June-July 2018 in Eldoret, Kenya. Participants were eligible if they (a) were the mother of at least one child and (b) self-identified as street-connected.

METHODS

Feasibility was measured via enrollment, attendance, drop-out rates, and engagement in take-away activities. Focus groups explored program acceptability and program outcomes. Self-report surveys assessed pre-post changes in child maltreatment, parental stress, parental sense of inefficacy, and positive parenting practices.

RESULTS

70% of participants attended ≥3/4 of sessions, 10% dropped out, and >50% of take-away activities were completed. Participants reported high acceptability and requested its continuation for themselves and other parents. There was an increase in supporting good behaviour (t(21)=8.15, p < .000) and setting limits (t(18) = 10.03, p < .000); a reduction in physical abuse (t(23) = -2.15, p = .042) and parental stress (t(22) = -7.08, p < .000); results for parental inefficacy were not statistically significant (t(22) = 0.15, p = .882).

CONCLUSIONS

The adapted program is feasible and acceptable to street-connected mothers, and may reduce child maltreatment and parental stress, and increase positive parenting. Further research should test program effectiveness.

Theoretical conceptions of intervention research addressing cancer control issues

Population health intervention research (PHIR) involves the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside of the health sector and have the potential to impact health at the population level. PHIR is a relatively new research field that has gained momentum internationally. When developing PHIR, it is important to have a program theory with the potential to increase intervention success by identifying underlying mechanisms, areas of failure and unintended outcomes. Since 2010, the French National Cancer Institute (Institut National du Cancer-INCa) has supported a national, competitive, dedicated call for proposals in PHIR to tackle cancer control issues. After 5 years of activity, specific analysis of the proposals submitted for funding and/or funded (n = 63) from descriptive and analytic perspectives was called for. Analysis of the data revealed diversity in terms of targeted populations, partnerships engaged and methodological approaches. Projects were more likely to be funded (n = 15) if presented with a robust methodological approach and diversity in methodology, and/or with research objectives at different levels of action. The analysis also revealed that researchers do not explicitly describe theoretical constructs underpinning their interventions to combat cancer. PHIR still needs improvement to better incorporate social, institutional and policy approaches to cancer control. Researchers should apply a theory-driven approach to distinguish between 'program failure' and 'theory failure'. Following up the funded projects will allow successes and failures to be evaluated with respect to the use (or non-use) of theory-driven approaches.

The Effects of Lifestyle Interventions on the Health-Promoting Behavior, Type D Personality, Cognitive Function and Body Composition of Low-Income Middle-Aged Korean Women

Low-income middle-aged women (LMW) who are vulnerable have various physical and psychosocial problems. They need lifestyle interventions to actively cope with these risk factors. This study used a randomized control group pretest-posttest design. LMW aged from 40 to 60 years were recruited and randomly assigned to an experimental group (n = 31) and a control group (n = 32). The lifestyle interventions for this study, which were implemented for eight weeks, included nutritional management, physical activity, stress management and cognitive function improvement based on King’s goal attainment theory. The measured outcomes were health-promoting behaviors, Type D personality, cognitive function and body composition. The experimental group scored significantly higher than the control group for health-promoting behaviors (effect size (ES) = 0.68~1.27, p < 0.001~0.014) and cognitive function (ES = 0.79~1.31, p < 0.001~0.005). The negative affectivity (ES = 0.70, p = 0.012) and the prevalence of a Type D personality (x² = 4.39, p = 0.047) and the systolic blood pressure (ES = 0.65, p = 0.019) decreased significantly in the experimental group compared with the control group. Lifestyle interventions for LMW were effective in improving health-promoting behavior, Type D personality traits and cognitive function.

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X-ray Confirmation

BACKGROUND

Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death.

AIMS

To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU.

METHODS

The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits).

RESULTS

Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site.

LINKING ACTION TO EVIDENCE

Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes

BACKGROUND

Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care.

AIMS

We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient's preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP.

METHODS

A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach.

RESULTS

The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes.

LINKING EVIDENCE TO ACTION

Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.

Evidence-informed interventions and best practices for supporting women experiencing or at risk of homelessness: a scoping review with gender and equity analysis

INTRODUCTION

While much of the literature on homelessness is centred on the experience of men, women make up over one-quarter of Canada's homeless population. Research has shown that women experiencing homelessness are often hidden (i.e. provisionally housed) and have different pathways into homelessness and different needs as compared to men. The objective of this research is to identify evidence-based interventions and best practices to better support women experiencing or at risk of homelessness.

METHODS

We conducted a scoping review with a gender and equity analysis. This involved searching MEDLINE, CINAHL, PsycINFO and other databases for systematic reviews and randomized trials, supplementing our search through reference scanning and grey literature, followed by a qualitative synthesis of the evidence that examined gender and equity considerations.

RESULTS

Of the 4102 articles identified on homelessness interventions, only 4 systematic reviews and 9 randomized trials were exclusively conducted on women or published disaggregated data enabling a gender analysis. Interventions with the strongest evidence included post-shelter advocacy counselling for women experiencing homelessness due to intimate partner violence, as well as case management and permanent housing subsidies (e.g. tenant-based rental assistance vouchers), which were shown to reduce homelessness, food insecurity, exposure to violence and psychosocial distress, as well as promote school stability and child well-being.

CONCLUSION

Much of the evidence on interventions to better support women experiencing homelessness focusses on those accessing domestic violence or family shelters. Since many more women are experiencing or at risk of hidden homelessness, population-based strategies are also needed to reduce gender inequity and exposure to violence, which are among the main structural drivers of homelessness among women.

Sexually Unexperienced Adolescents Benefit the Most From a Sexual Education Program for Adolescents: A Longitudinal Cluster Randomized Controlled Study

Using a longitudinal cluster-randomized controlled design, we examined whether the effects of Competencies for Adolescents with a Healthy Sexuality (COMPAS), an evidence-based sexual health promotion intervention, differ by adolescents' sexual experience. Participants were 699 students aged 14-16, 45.9% were sexually experienced, and assessed in the baseline, posttest, and 12- and 24-month follow-ups. All were recruited from 10 schools that were randomly assigned to the COMPAS program and waiting-list groups (WLG). Using an intent-to-treat analyses, longitudinal changes in psychosocial and behavioral outcomes were explored using generalized estimating equations. Compared to the WLG, COMPAS had a positive impact on six of the seven psychological and behavioral outcomes. Non-sexually experienced reported more favorable HIV-related attitudes, higher condom use intention, lower number of sexual partners, and higher condom use than those sexually experienced. Findings support the importance of implementing sex education actions before adolescents get involved in their first intimate relationships in order to achieve greater impact.

Development of a Generic Workshop Appraisal Scale (WASC) for Organizational Health Interventions and Evaluation

This study presents the development of a generic workshop appraisal scale (WASC) for the evaluation of organizational health interventions. Based on the session evaluation questionnaire (SEQ) by Stiles (1980), we developed a short, generic 10-item scale with pairs of adjectives, covering five facets: comprehensibility, relevance, novelty, activation, and valence. Our study is based on N = 499 employees from four organizations who participated in 41 workshops and filled out an evaluation questionnaire on-site. The questionnaire contained the newly developed WASC, as well as items capturing satisfaction with the developed output and outcome expectancies. Results from confirmative factor analysis confirmed the hypothesized five-factor structure of the WASC. The factor structure was found to be nearly invariant across the four organizations, a result that needs to be replicated in larger samples. Analysis of intra-class correlations indicated that 25% of the variance in workshop appraisal can be explained at workshop level. Hereby, perceived relevance and novelty exhibited lower amounts of shared variance, indicating that corresponding workshop appraisals are influenced more by individual factors and less by group dynamics. Furthermore, results from mediation analysis revealed that participants’ workshop appraisals were significantly related to their outcome expectancies, and that this relationship was mediated by output satisfaction. Again, the facets showed differential effects: Relevance and comprehensibility seem to contribute most to the total effect on outcome expectancy, followed by activation, whereas valence and especially novelty play a minor role. Taken together, participants’ workshop appraisals – together with output satisfaction and outcome expectancy – may be helpful for monitoring the implementation process and allow for corrective action if necessary.

Effects of a Lifestyle Intervention Based on Type D Personality in Overweight and Obese Middle-Aged Women: A Feasibility Study

BACKGROUND

Obesity is an important public health problem, particularly among middle-aged women. Type D personality, characterized by negative affectivity and social inhibition, is prevalent among obese and overweight middle-aged women and has been linked to maladaptive health-related behaviors and unhealthy lifestyle. Lifestyle interventions based on type D personality could be a first step in combatting obesity in middle-aged women.

AIM

To identify the effects of a lifestyle intervention based on type D personality on health-promoting lifestyle behaviors, psychological distress, type D personality, and body composition in overweight and obese middle-aged women.

METHODS

A total of 36 overweight and obese middle-aged women participated in a quasi-experimental design using a non-equivalent control group pretest-posttest. The experimental group received a total of eight sessions of a lifestyle intervention program based on type D personality over the course of four weeks. Outcomes were measured health-promoting lifestyle behaviors, psychological distress, type D personality, and body composition (body weight, body mass index, body fat, and abdominal fat).

RESULTS

Following the intervention, the experimental group scored significantly higher than the control group for health-promoting lifestyle behaviors, and significantly lower than the control group for psychological distress and type D personality. Body weight and body mass index decreased significantly in the experimental group compared to the control group.

LINKING EVIDENCE TO ACTION

Further research on various intervention programs for overweight and obese middle-aged women is warranted, including lifestyle interventions based on type D personality.

Applying the Haddon Matrix to evaluate sexual assault interventions on college campuses

Objective: A Haddon Matrix analysis was used to systematically review literature evaluating college campus sexual assault prevention programs to identify research gaps and intervention opportunities. Methods: Articles included were published from January 1, 2001 to December 31, 2017; indexed in PubMed, PsycInfo, or Scopus; involving English-speaking undergraduate students in the US; with experimental or quasi-experimental design. Results: All 31 eligible studies evaluated educational programing; all relied on self-report measures; and three-quarters had follow-up periods ≤ 6 months. Significant positive effects were reported by 6 of 10 studies that measured bystander behavior, 6 of 10 that educated potential victims and assessed victimization, and one of four that educated potential perpetrators and measured perpetration. Conclusion: The Haddon Matrix analysis identified the need for interventions that address perpetrators and the post-assault period, as well as studies of the impact of enforcing existing policies and new environmental and situational approaches to sexual assault prevention.

Inflammatory Biomarkers and Breast Cancer Risk: A Systematic Review of the Evidence and Future Potential for Intervention Research

Measuring systemic chronic inflammatory markers in the blood may be one way of understanding the role of inflammation in breast cancer risk, and might provide an intermediate outcome marker in prevention studies. Here, we present the results of a systematic review of prospective epidemiologic studies that examined associations between systemic inflammatory biomarkers measured in blood and breast cancer risk. From 1 January 2014 to 20 April 2020, we identified 18 unique studies (from 16 publications) that examined the association of systemic inflammatory biomarkers measured in blood with breast cancer risk using prospectively collected epidemiologic data. Only one marker, C-reactive protein, was studied extensively (measured in 13 of the 16 publications), and had some evidence of a positive association with breast cancer risk. Evidence associating other inflammatory biomarkers and more comprehensive panels of markers with the development of breast cancer is limited. Future prospective evidence from expanded panels of systemic blood inflammatory biomarkers is needed to establish strong and independent links with breast cancer risk, along with mechanistic studies to understand inflammatory pathways and demonstrate how breast tissue responds to chronic inflammation. This knowledge could ultimately support the development and evaluation of mechanistically driven interventions to reduce inflammation and prevent breast cancer.

Measuring health promotion research impact - What researchers think?

ISSUES ADDRESSED

The significant investment in health research has resulted in an increased focus to determine suitable approaches to measure health promotion research impact. This research was undertaken at the request of a nationally competitive research organisation that funds health promotion research, to explore how Chief Investigators (CIs) on their funded projects understood research impact, its measurement and associated challenges.

METHODS

Participants were required to be or have been a CI on an Australian competitive research (exploratory or intervention) grant focussed on health promotion. The qualitative study used thematic analysis from one-on-one interviews. Themes were created and descriptive quotes were selected to illustrate the main findings.

RESULTS

The majority of participants were female (n = 13) working at a university (n = 13). Three themes emerged: a) defining health research impact; b) complexity and simplicity of measuring health research impact; c) challenges of measuring health research impact: i) differing language; ii) differing assessment; iii) attribution and timing; and iv) resourcing and skills.

CONCLUSION

Researchers recognised that there are significant challenges in measuring the impact of health promotion research. The most significant factors identified by participants were the disciplinary background of the researchers undertaking the measurement, their skills and experience and the resources (including time) available to assess impact. SO WHAT?: Research impact assessment is complex, time consuming and requires specific skills to facilitate measurement of impact provision of funding for this activity in research grants and research impact training is required.

A systematic review of interventions for older adults living in jails and prisons

Objectives: The population of older adults in prison is the fastest growing demographic. Older inmates are more likely to have chronic medical conditions and cognitive decline, but these conditions occur earlier and may be more complex for older inmates. Specialized interventions to manage the unique health and mental health needs of older inmates are important to improve health and reduce burden on criminal justice systems. The aim of this research is to conduct a systematic review of empirically-tested interventions to improve the health or mental health of older adults living in jail or prison.Method: We conducted a systematic review of the literature to answer two research questions: (1) what interventions designed to improve the health or mental health of older adults living in jail or prison have been empirically tested? and (2) what are the effects of the interventions on inmates' physical or mental health?Results: Twenty-four articles were identified; seven met inclusion criteria. Several manuscripts discussed the same intervention, so the review identified five unique interventions for incarcerated older adults. The interventions are discussed including their main findings and limitations.Conclusion: Results support the need for research on interventions for incarcerated older adults. Intervention during incarceration can have a great impact on older adults' health and mental health during incarceration and upon reentry to the community. Directions for future research suggest the need for collaboration between practitioners and researchers in order to increase knowledge of what types of intervention work for older inmates living in jails and prisons.

Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health

Background

Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness.

Purpose

This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning.

Results

Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention.

Conclusions

We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.

Positionality of Community Health Workers on Health Intervention Research Teams: A Scoping Review

Community health workers (CHWs) are increasingly involved as members of health intervention research teams. Given that CHWs are engaged in a variety of research roles, there is a need for better understanding of the ways in which CHWs are incorporated in research and the potential benefits. This scoping review synthesizes evidence regarding the kinds of health research studies involving CHWs, CHWs' roles in implementing health intervention research, their positionality on research teams, and how their involvement benefits health intervention research. The scoping review includes peer-reviewed health intervention articles published between 2008-2018 in the U.S. A search of PubMed, Embase and CINAHL identified a total of 3,129 titles and abstracts, 266 of which met the inclusion criteria and underwent full text review. A total of 130 articles were identified for a primary analysis of the research and the level of CHWs involvement, and of these 23 articles were included in a secondary analysis in which CHWs participated in 5 or more intervention research phases. The scoping review found that CHWs are involved across the spectrum of research, including developing research questions, intervention design, participant recruitment, intervention implementation, data collection, data analysis, and results dissemination. CHW positionality as research partners varied greatly across studies, and they are not uniformly integrated within all stages of research. The majority of these studies employed a community based participatory research (CBPR) approach, and CBPR studies included CHWs as research partners in more phases of research relative to non-CBPR studies. This scoping review documents specific benefits from the inclusion of CHWs as partners in health intervention research and identifies strategies to engage CHWs as research partners and to ensure that CHW contributions to research are well-documented.

Enhancing Parenting Quality for Young Children Adopted Internationally: Results of a Randomized Controlled Trial

Children adopted internationally are often dysregulated biologically and behaviorally due to prior experiences of institutional care or caregiving changes and thus are in need of enhanced parental care. The present study assessed whether parents randomized to receive Attachment and Biobehavioral Catch-up (ABC) demonstrated significant improvements in parenting quality when compared to parents receiving a control intervention. Participants were 120 internationally adopted children and their adoptive parents. Sixty-three (52.5%) of the children and 113 (94.2%) of the primary caregivers were female. Children were adopted from several countries and predominantly from China, Russia, South Korea, and Ethiopia. The majority of parents identified themselves as White/non-Hispanic (95.0%). At the start of intervention, parents ranged in age from 26.2 to 51.1 years old (M= 39.7, SD = 6.0), and children ranged in age from 6.8 months to 48.4 months (M = 21.9, SD = 9.0). Sensitivity (i.e., contingent responsiveness to a child's cues), intrusiveness (i.e., physical and/or verbal behavior that interferes with a child's autonomy), and positive regard (i.e., positive affect expressed towards a child) were assessed at preintervention, immediately postintervention, and at annual follow-up visits. Parents who received ABC showed better parenting quality at postintervention than parents who received a control intervention, and these effects persisted at a 2-year follow-up. Findings add to the growing evidence that ABC improves parenting abilities, extending findings to adoptive parents and demonstrating that improvements in parenting quality were sustained several years after completion of the intervention. Trial registration: ClinicalTrials.gov NCT00816621.

Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice

BACKGROUND

Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal.

AIMS

The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections.

METHODS

This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data.

RESULTS

The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation.

LINKING EVIDENCE TO ACTION

The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.

Outpatient- or community-based interventions to prevent SIDS and sleep-related deaths

PURPOSE

To determine the state of science of outpatient- or community-based interventions for sudden infant death syndrome prevention in the United States, an integrative review was completed and studies identified through the application of inclusion and exclusion criteria.

CONCLUSIONS

Of the nine studies identified, three were randomized controlled trials. There was a wide range of measurement tools and variables measured. The timing of interventions also varied. There was a focus on mothers and African Americans. Lastly, study design and approach have not changed significantly over time.

PRACTICE IMPLICATIONS

Findings highlight recommendations for future research: expanding the target population, addressing culture in the development of the intervention or program, including additional providers, such as nurses, in the intervention or program, advancing innovation, and increasing rigor of study design.

Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism

Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.

Comparing the efficacy of integrative body-mind-spirit intervention with cognitive behavioral therapy in patient-caregiver parallel groups for lung cancer patients using a randomized controlled trial

Purposes/objectives: This paper reports the comparative efficacies of integrative body-mind-spirit intervention (I-BMS) and cognitive behavioral therapy (CBT) in patient-caregiver parallel groups for Chinese patients with lung cancer.Design: Randomized controlled trial (RCT).Methods: One hundred and fifty-seven patient-caregiver dyads with no marked functional impairment were randomized into one of the two interventions with eight weekly patient-caregiver parallel groups. Assessments were conducted at baseline, within one, eight- and sixteen-weeks post-intervention. Effects of treatment group across time were analyzed by multilevel modeling.Findings: CBT led to greater reduction in emotional vulnerability than I-BMS. I-BMS resulted in greater increase in overall QoL and spiritual self-care, and more reduction in depression than CBT. Patients in both interventions experienced improvement in physical, emotional and spiritual, except social, domains of QoL.Conclusion: I-BMS was more efficacious for diverse domains of QoL, and CBT was more effective for emotional well-being, despite the relatively small between-group effect sizes.Implications for psychosocial providers/policy: (1) With the expanding repertoire of psychosocial interventions for families facing lung cancer, it has become imperative to investigate the comparative efficacies of empirically supported and culturally adapted interventions. (2) Our findings show that I-BMS was more effective for diverse domains of QoL, while CBT was more efficacious with emotional well-being, although both interventions led to significant improvements in physical, emotional and spiritual domains of patient QoL. (3) Patient-caregiver parallel groups have been shown to be effective for enhancing QoL of Chinese lung cancer patients. (4) Care professionals are encouraged to dispense interventions based on the idiosyncratic needs and preferences of the patients to maximize the treatment effects.

"Architects of Their Own Brain." Social Impact of an Intervention Study for the Prevention of Gender-Based Violence in Adolescence

Research in psychology has evidenced both the prevalence of gender-based violence among youth worldwide and the negative impacts that such violence has on the victims’ mental and physical health. Neuroscience has proven that violent intimate relationships harm the brain, while very simple social experiences can change the brain architecture in positive directions. Also, interventions that have been demonstrated to be successful in preventing and responding to gender violence in adolescence have been informed by psychology. This article reviews the social impact of psychology in the field of teen gender violence and then reports on the potential social impact achieved by an intervention study consisting of seven interventions framed by the research line on the preventive socialization of gender violence. The program was addressed to 15- and 16-year-old adolescents and focused on supporting free reconstruction of mental and affective models of attractiveness via critical analysis of the dominant coercive discourse, which links attraction to violence. The communicative methodology involved working with an Advisory Committee from the beginning of the study, as well as continuous dialog between the researchers and the participants, which was used to refine subsequent interventions. The results show that the program contributed to raising participants’ critical consciousness regarding the dominant coercive discourse in their life, provided the participant subjects with cognitive tools to better understand their own and others’ sexual-affective thinking, emotions, and behaviors, in favor of rejecting violence, and supported the modification of female adolescents’ sexual preferences for different types of men. Importantly, the findings also indicate that the interventions aided some participants’ use of the knowledge gained in the project to help their friends and communities in reflecting upon coercive patterns of sexual attraction, the quality of their intimate relationships, and the different effects of sexual violence and toxic relationships on health. Some individuals reported leaving toxic relationships after the interventions. This intervention research illustrates Santiago Ramón y Cajal’s metaphor, employed to explain plasticity: that every person, if s/he decides it, can be the architect of her or his own brain. With evidence-based cognitive tools within the reach of every adolescent, and upon individual free choice for transformation, a new sexual-affective socialization free from violence is possible.

Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs)

INTRODUCTION

Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child's early years. This study examined the feasibility of implementing the NutriSTEP® screen-a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations-integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance.

METHODS

Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners' experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children.

RESULTS

Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements.

CONCLUSION

Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.

A Systematic Scoping Review of the Resilience Intervention Literature for Indigenous Adolescents in CANZUS Nations

Background: The concept of resilience offers a strengths-based framework for interventions to enhance Indigenous adolescent social and emotional well-being. Resilience interventions in or with schools encompass individual, social, and environmental factors that encourage health-promoting behaviors and assist adolescents in navigating toward resources that can sustain their health and well-being in times of adversity. This scoping review examined the literature on resilience-enhancing interventions for Indigenous adolescent students in Canada, Australia, New Zealand, and the United States (CANZUS nations). Intervention strategies, adherence to theoretical constructs, and outcomes were analyzed.

Methods: A systematic search was conducted of intervention studies aimed at improving Indigenous adolescent resilience and published in CANZUS nations between January 1990 and May 2016. Eleven peer-reviewed databases and 11 websites and clearing houses were searched for relevant studies. Following double-blinded screening, a total of 16 intervention papers were included for analysis. Study characteristics were identified and study quality was assessed using appropriate assessment tools.

Results: Twelve interventions (75%) were delivered in school settings and four (25%) were community-based, conducted in partnership with schools. Seven publications (44%) reported interventions focused exclusively on fostering individual resilience. Another seven (44%) included components that aimed to build staff, school, and/or community capacity to support adolescent resilience, and two (12.5%) had community/school capacity-building as the primary focus. Culturally based approaches to enhancing resilience were evident in most studies (81%). The publications documented the use of a range of program models, processes, and activities aligned with resilience theory. Positive outcomes were reported for improved individual assets (e.g., strengthened self-esteem and Indigenous identity), environmental resources (e.g., increased peer support and social/community connection), and increased community capacity (e.g., increased youth training and leadership opportunities). On average, study quality was assessed as moderate to high. The strongest evidence of intervention effectiveness was for improvements in mental health symptoms and outcomes.

Conclusion: Interventions indicated strong alignment with ecological and culturally based resilience theories and models. While the results of the studies indicate some positive impacts on the resilience of Indigenous adolescents, future evaluations should aim to ensure high study quality and focus on measuring strengths-based resilience outcomes.

Prevalence and Correlates of Depression, Anxiety, Stress, Healthy Beliefs, and Lifestyle Behaviors in First-Year Graduate Health Sciences Students

BACKGROUND

Graduate and professional students are reported to have higher than average rates of depression compared to age- and gender-matched populations. Further, more than half of student health visits are due to anxiety, yet little is known about the relationships among depression, anxiety, and healthy lifestyle behaviors in this population as well as what factors predict depression and anxiety.

AIMS

The purposes of this study were as follows: (a) to examine the prevalence of depression, anxiety, stress, physical health, healthy beliefs, and lifestyle behaviors in incoming first-year health sciences professional students; (b) to describe the relationships among these variables; and (c) to determine predictors of depression and anxiety.

METHODS

A descriptive correlational study design was used with baseline data collected from first-year graduate health sciences students from seven health professions colleges who were participating in a wellness onboarding intervention program, including Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine.

RESULTS

Seventeen percent of incoming students reported moderate-to-severe depressive symptoms with 6% reporting suicidal ideation. In addition, 14% of the participating students reported moderate-to-severe anxiety. Factors that predicted depression and anxiety included having less than 7 hr of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control.

LINKING EVIDENCE TO ACTION

These findings highlight the need to routinely screen incoming health sciences students for depression and anxiety upon entrance into their academic programs so that evidence-based interventions can be delivered and students who report severe depression or suicidal ideation can be immediately triaged for further evaluation and treatment. Providing cultures of well-being and emphasizing self-care throughout academic programs also are essential for students to engage in healthy lifestyles.