Identifying the capabilities for creating next-generation registries: a guide for data leaders and a case for "registry science"

OBJECTIVE

The increasing demands for curated, high-quality research data are driving the emergence of a novel registry type. The need to assemble, curate, and export this data grows, and the conventional simplicity of registry models is driving the need for advanced, multimodal data registries-the dawn of the next-generation registry.

MATERIALS AND METHODS

The article provides an outline of the technology roles and responsibilities needed for successful implementations of next-generation registries.

RESULTS

We propose a framework for the planning, construction, maintenance, and sustainability of this new registry type.

DISCUSSION

A rubric of organizational, computational, and human resource needs is discussed in detail, backed by over 40 years of combined in-the-field experiences by the authors.

CONCLUSIONS

A novel field, registry science, within the clinical research informatics domain, has arisen to offer its insights into conceiving, structuring, and sustaining this new breed of tools.

Possible Mental Health Interventions for Family Members of a Close Relative Who Has Suicidal Thoughts or Committed Suicide: A Pilot Project at a Mental Health Center

Background: Suicides are an actual issue, especially in Lithuania, where, despite significant efforts, the number of suicides remains very high. In cases of suicide, society painfully loses its members, and the relatives of the person who committed suicide, engaged in self-harm, or attempted suicide face many negative experiences. Methods: The purpose of this article is to describe the pilot project applied for 2 years in the Mental Health Center (MHC) in the city of Vilnius, Lithuania, in organizing and providing services to people whose relatives committed suicide or attempted suicide or self-harm. This prevention and early intervention program, organized by an interdisciplinary team at an MHC, appeared appropriate, effective, and well-attended. Program clients could participate anonymously and have the opportunity to choose the time and the right services for themselves from the offered program services package. Results: Providing the possibility for family members to receive flexible mental health services at the primary center increased the attractiveness of the program and reduced stigma. Conclusions: The program results demonstrated the applicability of the implementation of such an initiative as a relevant possibility when providing complex help for the relatives of self-harming and/or suicidal people.

Childhood Obesity as a Global Problem: a Cross-sectional Survey on Global Awareness and National Program Implementation

Objective

The rising global epidemic of childhood obesity is a major public health challenge. Despite the urgency, there is a lack of data on the awareness and implementation of preventative measures. The aim of this study was to identify areas for improvement in the prevention and management of childhood obesity worldwide.

Methods

A cross-sectional electronic survey was distributed to 132 members of national pediatric societies of the International Pediatric Association.

Results

Twenty-eight (21.2%) participants, each from a different country across six World Health Organization (WHO) regions completed the survey. Most participants reported that national prevalence data of childhood obesity is available (78.6%), and the number increased during the Coronavirus disease-2019 pandemic (60.7%). In most countries (78.6%), the amount of sugar and salt in children’s products is provided but only 42.9% enacted regulations on children-targeted advertising. Childhood obesity prevention programs from the government (64.3%) and schools (53.6%) are available with existing support from private or non-profit organizations (71.4%). Participants were aware of WHO’s guidance concerning childhood obesity (78.6%), while fewer were aware of The United Nations International Children’s Emergency Fund’s (UNICEF) guidance (50%). Participants reported that WHO/UNICEF guidance acted as a reference to develop policies, regulations and national programs. However, progress was hindered by poor compliance. Lastly, participants provided suggestions on tackling obesity, with responses ranging from developing and reinforcing policies, involvement of schools, and prevention across all life stages.

Conclusion

There are different practices in implementing prevention measures to counter childhood obesity globally, particularly in statutory regulation on food advertising and national programs. While support and awareness was relatively high, implementation was hindered. This reflects the need for prompt, country-specific evaluation and interventions.

Mobile-Delivered Mindfulness Intervention on Anxiety Level Among College Athletes: Randomized Controlled Trial

BACKGROUND

College athletes are a group often affected by anxiety. Few interventional studies have been conducted to address the anxiety issues in this population.

OBJECTIVE

We conducted a mobile-delivered mindfulness intervention among college athletes to study its feasibility and efficacy in lowering their anxiety level and improving their mindfulness (measured by the Five Facet Mindfulness Questionnaire [FFMQ]).

METHODS

In April 2019, we recruited 290 college athletes from a public university in Shanghai, China, and 288 of them were randomized into an intervention group and a control group (closed trial), with the former (n=150) receiving a therapist-guided, smartphone-delivered mindfulness-based intervention and the latter receiving mental health promotion messages (n=138). We offered in-person instructions during the orientation session for the intervention group in a classroom, with the therapist interacting with the participants on the smartphone platform later during the intervention. We used generalized linear modeling and the intent-to-treat approach to compare the 2 groups' outcomes in dispositional anxiety, precompetition anxiety, and anxiety during competition, plus the 5 dimensions of mindfulness (measured by the FFMQ).

RESULTS

Our intent-to-treat analysis and generalized linear modeling found no significant difference in dispositional anxiety, precompetition anxiety, or anxiety during competition. Only the "observation" facet of mindfulness measures had a notable difference between the changes experienced by the 2 groups, whereby the intervention group had a net gain of .214 yet fell short of reaching statistical significance (P=.09). Participants who specialized in group sports had a higher level of anxiety (β=.19; SE=.08), a lower level of "nonjudgemental inner experience" in FFMQ (β=-.07; SE=.03), and a lower level of "nonreactivity" (β=-.138; SE=.052) than those specializing in individual sports.

CONCLUSIONS

No significant reduction in anxiety was detected in this study. Based on the participant feedback, the time availability for mindfulness practice and session attendance for these student athletes in an elite college could have compromised the intervention's effectiveness. Future interventions among this population could explore a more student-friendly time schedule (eg, avoid final exam time) or attempt to improve cognitive and scholastic outcomes.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900024449; https://www.chictr.org.cn/showproj.html?proj=40865.

A Web-Based Peer-Patient Navigation Program (Compassionate Online Navigation to Enhance Care Transitions) for Youth Living With Childhood-Acquired Disabilities Transitioning From Pediatric to Adult Care: Qualitative Descriptive Study

BACKGROUND

Studies have highlighted significant challenges associated with the transition from pediatric to adult health and social care services for youth living with childhood-acquired disabilities and their caregivers. Patient navigation has been proposed as an effective transitional care intervention. Better understanding of how patient navigation may support youth and their families during pediatric to adult care transitions is warranted.

OBJECTIVE

This study aims to describe the preferred adaptations of an existing web-based platform from the perspectives of youth with childhood-onset disabilities and their family caregivers to develop a web-based peer-patient navigation program, Compassionate Online Navigation to Enhance Care Transitions (CONNECT).

METHODS

A qualitative descriptive design was used. Participants included youth living with childhood-acquired disabilities (16/23, 70%) and their caregivers (7/23, 30%). Semistructured interviews and focus groups were conducted, digitally recorded, and transcribed. Thematic analysis was used to analyze the data and was facilitated through NVivo software (Lumivero).

RESULTS

Participants desired a program that incorporated (1) self-directed learning, (2) a library of reliable health and community resources, and (3) emotional and social supports. On the basis of participants' feedback, CONNECT was deemed satisfactory, as it was believed that the program would help support appropriate transition care through the provision of trusted health-related information. Participants highlighted the need for options to optimize confidentiality in their health and social care and the choice to remain anonymous to other participants.

CONCLUSIONS

Web-based patient navigation programs such as CONNECT may deliver peer support that can improve the quality and experience of care for youth, and their caregivers, transitioning from pediatric to adult care through personalized support, health care monitoring, and health and social care resources. Future studies are needed to test the feasibility, acceptability, usability, use, and effectiveness of CONNECT among youth with childhood-onset disabilities.

Considerations for Correction of Micronutrient Deficiencies Through Supplementation in Pregnant Women and Children Under-5 in Latin America

BACKGROUND

Micronutrient deficiencies in Latin America are a public health concern, nonetheless, lack of information still exists in many countries, so that the true magnitude of the problem remains uncertain.

OBJECTIVE

To summarise experiences that can inform the development of policies and programs to address micronutrient deficiencies throung supplementation in pregnant women and chlidren under five years of age in Latin American.

METHODS

Review of the most evidence on the effects of micronutrients supplementation, focusing on pregnant women and children under five years of age.

RESULTS

Certain population groups, as women of reproductive age and children under 2 years of age, are at increased risk for deficiency due to their high micronutrient requirements. This is compounded by the limited access to micronutrient-rich foods for many people living in vulnerable situations. Micronutrient supplementation is an effective intervention to prevent and treat deficiency and to mitigate its adverse effects on health, nutrition, and pregnancy outcomes in micronutrient-deficient populations. The potential benefits of supplementation programs, however, are realized only when they reach those who have the potential to benefit, that is, with inadequate intakes of micronutrients from dietary sources, and when the quality of design and delivery of the programs aresufficient to reach that population timely, regularly, and effectively to enable and motivate consumption.

CONCLUSIONS

Several resources and experiences exist that can help favor the development of programs that can realize this biological and programmatic potential. There is need for continuous efforts to augment coverage and achieve results that can translate into economic benefits for individuals, families, and nations.

Developing Cardio-Oncology Programs in the New Era: Beyond Ventricular Dysfunction Due to Cancer Treatments

Cardiovascular disease is a common problem in cancer patients that is becoming more widely recognized. This may be a consequence of prior cardiovascular risk factors but could also be secondary to the anticancer treatments. With the goal of offering a multidisciplinary approach to guaranteeing optimal cancer therapy and the early detection of related cardiac diseases, and in light of the recent ESC Cardio-Oncology Guideline recommendations, we developed a Cardio-Oncology unit devoted to the prevention and management of these specific complications. This document brings together important aspects to consider for the development and organization of a Cardio-Oncology program through our own experience and the current evidence.

Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study

BACKGROUND

Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing.

OBJECTIVE

This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking.

METHODS

This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined.

RESULTS

The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months.

CONCLUSIONS

The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027.

School-Based Nutrition Programs in the Eastern Mediterranean Region: A Systematic Review

This systematic review aims at documenting government-led school nutrition programs/interventions in countries of the Eastern Mediterranean Region (EMR). A systematic review of the available literature on this topic was conducted between 25 October 2022 and 15 November 2022 using 15 electronic databases as well as grey literature. The search was limited to materials published post 2000 in English, Arabic, or French. Articles/Reports were included in the review if they provided information on school-based nutrition programs/interventions developed, adopted or implemented by a governmental entity in the EMR countries, irrespective of study design. In total, 158 documents were retained until 16 May 2023. School-based programs/interventions were categorized into 13 types. In total, 298 school-based nutrition programs/interventions were identified. The most common were school meals and school feeding programs (all EMR countries) followed by nutrition education within the curriculum (77% of countries), extracurricular nutrition education (64%), standards for school canteens or foods/beverages available in schools (64%), and training of school staff (59%). Approximately half reported the inclusion of fruit and vegetable schemes (54%) or the establishment of hygienic cooking facilities (50%), while less than half reported standards for the marketing of food/beverages (45%), bans/standards for vending machines, milk feeding schemes, or micronutrient supplementation programs (41%). The least common interventions were school gardens (32%) and take-home rations (14%). Countries with the lowest gross domestic product and lowest government effectiveness score had the lowest number of programs/interventions. Many of the programs have tackled both school-aged children as well as preschoolers. We were able to identify monitoring and process evaluation for 21 programs in 14 countries. Few programs have undergone impact assessment.

Supportive Interventions for Caregivers of Individuals With Multiple Sclerosis: A Systematic Review

BACKGROUND

Caregivers of individuals with multiple sclerosis (MS) are key members of the treatment team. Their needs and challenges should be met as interventions can be effective in improving not only their own health, well-being, and quality of life but also that of those they care for. The aim of this systematic review was to investigate supportive interventions for caregivers of individuals with MS.

METHODS

We conducted a database search of PubMed, Google Scholar, Science Direct, Scopus, and the Cochrane Library from 2000 to 2021. English-language studies that examined interventions administered directly to caregivers of individuals with MS and evaluated various outcomes were included. The Downs and Black checklist was used to assess the methodological quality of included studies.

RESULTS

Twenty of 367 relevant papers fit the eligibility criteria outlined in the methods of this study and were subsequently selected for this review. Of the included studies, there was a notable variance in key characteristics such as methods, outcome measures, sample size, and procedures. Supportive interventions, psychoeducational group interventions, and behavioral-adaptive therapies were the 3 main categories of interventions reviewed; however, each study had a significant correlation between the intervention and outcomes.

CONCLUSIONS

Despite the small sample size in this study, this review showed that various intervention models that target caregivers of individuals with MS have been successful.

Effect of Personalized Email-Based Reminders on Participants' Timeliness in an Online Education Program: Randomized Controlled Trial

BACKGROUND

Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students' study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination.

OBJECTIVE

The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time.

METHODS

Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course.

RESULTS

In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one's studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time.

CONCLUSIONS

Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was-adding a few words with the page number the student ought to be on to a reminder-we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming.

Artificial Intelligence Program for Predicting Wrestlers' Sports Performances

To date, there are conflicting opinions about the effectiveness of the introduction of artificial intelligence technologies in sports. In this regard, the purpose of the study was to develop and integrate an intellectual program for predicting competitive success into the process of selecting wrestlers to increase its effectiveness. The authors developed a program for predicting the sports performance of wrestlers on the basis of artificial intelligence technology. To implement the study, the individual data of Greco-Roman wrestlers (n = 72) were collected and processed on 36 comparison traits, ranked into categories according to three key areas: sports space, hereditary data and individual achievements. As a result of data processing through means of deep neural networks and machine learning algorithms, two prediction categories were identified: athletes who performed at the sport rank or the highest standard and athletes who did not achieve this standard. Control testing of the created program showed only 11% of error probability in predicting a given wrestler's competitive performance. As for the functionality of the program in the area of classification of the features by category, the authors' artificial intelligence program with 100% probability identified key categories of traits that reliably affect the results of the future sports performance of a young wrestler. Thus, the use of neural networks and machine learning algorithms, according to the results of the study, improves the quality of sports selection, which will allow further timely individualization and improvement of the training process of young wrestlers.

Empowering Students against Ethnic Bullying: Review and Recommendations of Innovative School Programs

Despite research on anti-bullying interventions, there is no systemic approach or resources for teachers to address ethnic and race-related bullying in schools. In this article, we selectively reviewed theories and programs to help teachers identify and address ethnic bullying in their classrooms. We provide recommendations for workshops (e.g., cultural awareness training, empathy-building activities, bystander intervention, and stigma-based intervention). These anti-ethnic bullying workshops should promote understanding of different cultures, strengthen empathy for those who are different, encourage bystanders to take action, and reduce stigma and stereotypes. Through the sharing of diverse perspectives, expertise, and experiences, we hope this article can cultivate interactive dialogues and collaborations between educators and researchers to effectively address ethnic and race-related bullying.

Active Home Literacy Environment: parents' and teachers' expectations of its influence on affective relationships at home, reading performance, and reading motivation in children aged 6 to 8 years

Studies highlight the benefits of active Home Literacy Environment on learning and reading habits. This model is based on harnessing family involvement, resources and capabilities to create learning opportunities around reading, engaging in practices related to written language at home. However, it is less common to find applied research with children from the age of six, with older ages and already initiated in reading decoding. The aims are confirming and improving the expectations of families and teachers of a group of children (6-8 years old) regarding the effect of an active Home Literacy Environment program on the improvement of affective relationships between parents and children, reading performance, and children's reading motivation. The method and procedure followed included carrying out an active Home Literacy Environment program for 18 months with a group of children (aged 6 to 8 years), their families and their teachers, and measures of all variables were collected at four times, using an Ad Hoc instrument designed for families and teachers. The results show that participants had high expectations about the influence of the Home Literacy Environment on the improvement of all variables even before the implementation of the program, improving their expectations about its effects on positive affective relationships at home and on reading achievement after the intervention. In conclusion, we suggest the need to continue investigating the effects of the active Home Literacy Environment program applied to children aged 6 to 8 years, older than those traditionally investigated. As well as their effects on family relationships, reading ability, and reading motivation.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

"Out-of-Hospital and with Qualified Exercise Professionals": Keys to the CORTEX-SP Physical Exercise Program According to the Experience of the Participants

Physical exercise programs are useful and necessary for the treatment of schizophrenia. The aim of this study was to assess the experiences of participants with schizophrenia in an out-of-hospital exercise program designed and supervised by qualified exercise professionals. Thirty-five individuals with schizophrenia from the intervention group of the CORTEX-SP study were interviewed. The interviews were transcribed verbatim and content analysis was performed using inductive coding. Two main categories emerged: the importance of the program being conducted out-of-hospital, and the individuals responsible for the program being qualified exercise professionals. The participants highlighted the importance of conducting the program outside the psychiatric center since it gave them greater satisfaction. They perceived greater seriousness and a greater number of resources and felt encouraged to repeat the program or prolong it. The success of the program, in addition to the space, was due to the personnel in charge of the program, i.e., the qualified exercise professionals, and the fact that the activities were designed and supervised. Participants emphasized the qualifications of the exercise professionals, key for this type of program, their social skills and the level of involvement with participants and their follow-up.

A case study of the long-term sustainability of an oral health program for persons experiencing homelessness

Stakeholders engaged in funding health programs and investing in human capital are concerned that their investments lead to beneficial long-term outcomes and do not fade from existence when funding streams dry up. However, dissemination and implementation researchers often pay little attention to what happens after programs are implemented. An essential function of the public health nurse operating at the executive management or leadership level is to evaluate overall effectiveness, quality, and sustainability of programs and to design systems-level quality initiatives and evaluation plans that foster program sustainability. This article applies a conceptual framework for sustainability to an oral health program serving persons experiencing homelessness, exploring the essential programmatic, community, and organizational factors that have positively impacted the long-term sustainability of the program. Lessons learned from a model program that has thrived in a political and economic resource poor climate may assist the public health nurse in planning and developing health programs that can withstand the test of time even in the most challenging of circumstances.

Enabling Multicentric Participatory Disease Surveillance for Global Health Enhancement: Viewpoint on Global Flu View

Participatory surveillance (PS) has been defined as the bidirectional process of transmitting and receiving data for action by directly engaging the target population. Often represented as self-reported symptoms directly from the public, PS can provide evidence of an emerging disease or concentration of symptoms in certain areas, potentially identifying signs of an early outbreak. The construction of sets of symptoms to represent various disease syndromes provides a mechanism for the early detection of multiple health threats. Global Flu View (GFV) is the first-ever system that merges influenza-like illness (ILI) data from more than 8 countries plus 1 region (Hong Kong) on 4 continents for global monitoring of this annual health threat. GFV provides a digital ecosystem for spatial and temporal visualization of syndromic aggregates compatible with ILI from the various systems currently participating in GFV in near real time, updated weekly. In 2018, the first prototype of a digital platform to combine data from several ILI PS programs was created. At that time, the priority was to have a digital environment that brought together different programs through an application program interface, providing a real time map of syndromic trends that could demonstrate where and when ILI was spreading in various regions of the globe. After 2 years running as an experimental model and incorporating feedback from partner programs, GFV was restructured to empower the community of public health practitioners, data scientists, and researchers by providing an open data channel among these contributors for sharing experiences across the network. GFV was redesigned to serve not only as a data hub but also as a dynamic knowledge network around participatory ILI surveillance by providing knowledge exchange among programs. Connectivity between existing PS systems enables a network of cooperation and collaboration with great potential for continuous public health impact. The exchange of knowledge within this network is not limited only to health professionals and researchers but also provides an opportunity for the general public to have an active voice in the collective construction of health settings. The focus on preparing the next generation of epidemiologists will be of great importance to scale innovative approaches like PS. GFV provides a useful example of the value of globally integrated PS data to help reduce the risks and damages of the next pandemic.

Autonomy, self-realization, and psychological empowerment: a prospective mixed methods study of the effects of residential immersive life skills programs for youth with physical disabilities

PURPOSE

To examine changes in self-determination associated with youth participation in residential immersive life skills (RILS) programs.

METHOD

In this prospective mixed methods study, the Arc's Self-Determination Scale was administered pre- and post-program, and at 3- and 12-month follow-ups, to 27 RILS youth and a comparison group of 11 youth enrolled in a non-residential life skills program. Ten RILS youth were interviewed 3 and 12 months post-program, with content analysis used to explore changes in autonomy, self-realization, and psychological empowerment.

RESULTS

RILS youth showed statistically significant increases in autonomy immediately after the program, which were maintained one year later, whereas the comparison group displayed increased autonomy only at 3 months post-program. Qualitatively, RILS youth emphasized changes in behavioral autonomy and psychological empowerment 3 months post-program, whereas at one year there was greater emphasis on changes in self-realization. Using a triangulation protocol, the mixed methods data were interpreted as showing agreement regarding changes in autonomy due to intervention, partial agreement regarding self-realization, and dissonance regarding psychological empowerment.

CONCLUSIONS

RILS programs can enhance the autonomy of youth with physical disabilities and contribute to their sense of confidence and understanding of themselves as they move forward in life.

Status of Onchocerciasis Elimination in Gabon and Challenges: A Systematic Review

Control and treatment programs (CDTI) have been set up nationally in all endemic countries to overcome the impact of onchocerciasis on the affected populations. However, Gabon must still succeed in setting up real onchocerciasis control programs. Here, various database articles have been used to provide the scientific community with a summary document showing the mapping of this disease in Gabon. The articles dealing with onchocerciasis, animal reservoirs, surveillance, and elimination were analyzed. Results showed that little research has been performed. Most studies are concentrated in one region (The area of Lastourville). In addition, we observed that the distribution of the disease varies significantly across the country. Indeed, specific environments present a hyper-endemicity of the disease, while others are meso and hypo-endemic. So, we found some departments with a prevalence ranging from 0% to over 20%; within them, villages had infection levels comprising 10% to 60%, indicating potential hotspots. Vectors activities were studied in some areas. This paper showed the challenges encountered in the country to eliminate this disease. One solution is a deeper understanding of the disease's bioecology to establish effective health policies to eliminate onchocerciasis in Gabon effectively.

Preparing clinicians to be site investigators in multicenter clinical trials: A training program at an academic medical center

Clinical trials are essential in the translation of biomedical discoveries to new clinical interventions and therapeutics. Successful multisite clinical trials require qualified site investigators with an understanding of the full spectrum of processes and requirements from trial identification through closeout. New site investigators may be deterred by competing demands on their time, the complexity of administrative and regulatory processes for trial initiation and conduct, and limited access to experienced mentor networks. We established a Clinical Trialist Training Program (CTTP) and complimentary Clinical Trials Bootcamp at our institution to address these barriers and increase the number of local site investigators enabled to lead successful clinical trials. An initial cohort of four CTTP scholars received salary support with protected time, didactic training, assistance with study identification and start-up navigation, and quarterly progress meetings. By the end of the 12-month program, this initial cohort identified 33 new trials, utilized feasibility assessments, and reported being on target to sustain their protected time from new clinical trials. Bootcamp attendees demonstrated increased knowledge of resources, offices, and processes associated with clinical trial conduct. Our results support providing compensated protected time, training, and access to experienced clinical research professionals to enable clinicians to become successful site investigators.

Effect of the Parenting Preparation Program on Maternal Role Competence: A Systematic Review and Meta-Analysis

Background

The maternal sense of competence refers to the mother's sense of ability to care for the baby. Maternal competence can affect the mother's parenting capacities. Maternal preparation programs are aimed to increase mothers' knowledge and improve their maternal competence. This systematic review and meta-analysis investigated the effect of a maternal preparation program on maternal role competence.

Materials and Methods

A systematic search was conducted using the following MeSH terms: "education", "program", and "parenting sense of competence" in databases including PubMed, Web of Science, Cochrane Central, and Scopus, from inception till July 2022. All Randomized Controlled Trials (RCTs) published in any language were extracted. Articles were screened based on predefined inclusion and exclusion criteria. The quality of the included articles was assessed by two qualified reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

Of the 170 published works that were retrieved in the initial stage, five articles including 647 first-time mothers were analyzed. A meta-analysis showed that parenting preparation program interventions increased maternal role competence in first-time mothers as opposed to those who received routine care Mean Difference (MD) = 3.31, 95% Confidence Interval (CI) [2.07, 4.55].

Conclusions

The results of this study encourage health policymakers to develop maternal preparation programs for first-time mothers and their children.

Systematic Review of Culturally-Based Breast Cancer Health Studies in Hawai'i

Breast cancer disproportionately impacts Native Hawaiian and Pacific Islander communities in Hawai'i, as exemplified by high breast cancer prevalence and mortality rates. Breast cancer disparities are linked to socio-cultural determinants of health, signifying the importance of culturally-based interventions. This paper systematically reviewed breast cancer studies conducted in Hawai'i. The literature search yielded 813 published studies, with a final total of 13 peer-reviewed studies that met this paper's inclusion criteria. All but 1 study incorporated cultural components. By evaluating key intervention components and assessing the quality of each study, the research team aimed to analyze the importance of cultural values in health interventions. Family and spirituality in coping with a cancer diagnosis were key themes in patients' lived experiences. Other culturally-based components in these studies included community-engaged research and cultural training for health professionals. The collective findings suggest that breast cancer health interventions that incorporate cultural strengths, values, and worldviews may play a central role in reducing the overall breast cancer burden among these communities. The present review advocates for future research to take a more culturally-based strategy in addressing breast cancer health disparities among Native Hawaiian and Pacific Islanders in Hawai'i.

Effect of a self-care program among women with urinary incontinence: A quasi-experimental study

Urinary incontinence is a multifactorial health problem that significantly affects women's quality of life. This quasi-experimental pre/post-test study aimed to evaluate the effect of a self-care program on women suffering from urinary incontinence. The study was conducted at the urodynamic unit within Ain Shams Maternity University Hospital, with a purposive sample of 100 women diagnosed with urinary incontinence, with no medical or surgical conditions, and who were not pregnant. A structured interview questionnaire and women's self-care practices checklists were used as study tools. The results showed that 72.0% of the study group and 68.0% of the control group were housewives. Significantly improved self-care practices and bladder retraining were observed in the study group compared to the control group post-intervention and during follow-up (p<0.001). Furthermore, the study group demonstrated a reduction in the severity of urinary incontinence and improved health practices, whereas the control group did not exhibit significant changes. These findings emphasize the significance of self-care programs in managing urinary incontinence and enhancing women's quality of life.

Yemen Advanced Field Epidemiology Training Program: An Impact Evaluation, 2021

This is the first evaluation of the Yemen Field Epidemiology Training Program (Y-FETP) to assess if it met its objectives. We collected data using mixed methods including desk review, a focus group discussion with the Y-FETP staff, in-depth interviews with 21 program stakeholders, and an online survey for the program's graduates. We transcribed/analyzed qualitative data using explanatory quotations and survey data using descriptive methods. The desk review indicated that Y-FETP covers 18 (82%) out of 22 governorates and conducted >171 outbreak investigations, 138 surveillance system analyses/evaluations, 53 planned studies, published >50 articles and had >155 accepted conference abstracts. Qualitative findings showed Y-FETP helped save lives and reduced morbidity/mortality using building capacities in outbreak response; provided evidence-based data for decision-making; and increased awareness about public health issues. An online survey showed that Y-FETP helped 60 to 80% of graduates conduct outbreak investigations, surveillance analysis/evaluation, manage surveillance systems/projects, engage in public health communication (reports/presentation), and use basic statistical methods. However, the evaluation revealed that Y-FETP is primarily funded by donors; thus, it is not sustainable. Other challenges include low graduate retention and limited training in policy development and management. Y-FETP achieved its main objectives of increasing the number of epidemiologists in the workforce, making a positive impact on public health outcomes.

A Web-Based Sexual Violence, Alcohol Misuse, and Bystander Intervention Program for College Women (RealConsent): Randomized Controlled Trial

BACKGROUND

Sexual violence (SV) incidence among college women has been invariant for the past 20 years. Innovative prevention strategies that are low resource and technology driven but demonstrate efficacy are greatly needed.

OBJECTIVE

The aim of this study was to determine the efficacy of a novel theoretically driven internet-based intervention for first-year college students who identify as women (RealConsent) in reducing their risk of exposure to SV and alcohol misuse as well as increasing alcohol protective and bystander behaviors.

METHODS

This randomized controlled trial involved first-year college students who identified as women (n=881) attending 1 of 3 universities in the southeastern United States. Participants aged 18 to 20 years were randomized to RealConsent (444/881, 50.4%) or to an attention-matched placebo control (437/881, 49.6%). RealConsent is fully automated and consists of four 45-minute modules that incorporate entertainment-education media and proven behavior change techniques. The primary outcome was exposure to SV; the secondary outcomes were alcohol protective behaviors, dating risk behaviors, alcohol misuse, and bystander behavior. Study outcomes were assessed at baseline and 6-month follow-up.

RESULTS

Among participants with some exposure to SV, those in the RealConsent group experienced less exposure to SV than the placebo group (adjusted incidence rate ratio 0.48, 95% CI 0.33-0.69; P=.002). Furthermore, participants in the RealConsent group engaged in more alcohol protective behaviors (adjusted odds ratio 1.17, 95% CI 0.12-2.22; P=.03) and were less likely to binge drink (adjusted incidence rate ratio 0.81, 95% CI 0.67-0.97; P=.003). Finally, participants in the RealConsent group who had 100% dosage were more likely to engage in bystander behavior than those with <100% dosage plus placebo group (adjusted odds ratio 1.72, 95% CI 1.17-2.55; P=.006).

CONCLUSIONS

A comprehensive exposure to SV, alcohol use, and bystander educational program was successful in decreasing the occurrence of exposure to SV among those most at risk and in increasing alcohol protective behaviors. Because of its web-based and mobile technologies, RealConsent can be easily disseminated and holds potential for reducing campus SV.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03726437; https://clinicaltrials.gov/ct2/show/NCT03726437.

Screening Guidelines and Programs for Cervical Cancer Control in Countries of Different Economic Groups: A Narrative Review

Screening guidelines and practices differ according to resource availability and continually update as scientific developments take place. In this article, we have reviewed screening guidelines and programs for cervical cancer prevention in selected countries belonging to different economic groups viz high income, middle income, and low income. We have selected six countries - the United States of America (USA), the United Kingdom (UK), India, South Africa, Bangladesh, and Malawi. Considerable differences are observed across the health systems. Countries with established screening guidelines complemented by organised nationwide programs or insurance practices have much better screening rates. Human Papilloma Virus (HPV) DNA testing is currently the test of choice in the majority of settings for cervical cancer screening due to its higher sensitivity (up to 90-100%) and longer screening intervals (three to five years). It is also cost-effective, less dependent on operator expertise, and suitable for all settings as compared to a Pap smear test or visual inspection with acetic acid (VIA). Self-sampling of HPV can further help to improve screening coverage by increasing opportunities of reaching to women who would otherwise not participate in screening programs. Resource-constrained countries recommend VIA-based screening in their national programs due to its low cost. The share of cervical cancer is higher in middle and low-income countries as they have lower screening coverage, compared to high-income countries. The main barriers faced in the implementation of the program in low-income countries (LICs) are pertaining to the health system, patient-specific challenges, and healthcare provider-specific challenges.

Implementation of a Treatment Program for Individuals Imprisoned for Sex Offenses in Uruguay: Achievements, Problems and Challenges

Treatment for individuals convicted of sex offenses has substantially improved in developed countries in recent decades, providing practitioners with an extensive literature to guide the implementation of effective programs to reduce sexual reoffending. Nevertheless, sexual offending rehabilitation is still in its infancy in Latin American countries such as Uruguay, so little is known about the transference and implementation of evidence-based programs. The current study examines the strengths, barriers, and challenges of implementing a sex offenses treatment program in Uruguay. The findings suggest some achievements of the program, but also several problems with implementation. Some problems are universal among different countries (e.g., scarce resources and facilities, insufficiently trained staff, and unexpected changes in the organization), but others were particularly relevant in the Uruguayan context (e.g., government policy alien to a rehabilitation approach, lack of appropriate prison facilities, lack of training for therapists from a cognitive-behavioral perspective). All these difficulties must be anticipated and solved for successful generalizability of rehabilitation programs to different correctional systems.

Development and evaluation of a school-based physical literacy intervention for children in Germany: protocol of the PLACE study

Introduction

Fueled by the COVID-19 pandemic, the physical activity behavior of children has reached a concerning level nowadays. By empowering individuals to be physically active throughout the life course, the concept of physical literacy has recently gained increasing attention and adopts a holistic-integrative perspective on PA promotion. Although the field has successively attempted to translate the conceptual ideas of physical literacy into interventions, the theoretical base is heterogeneous and is often lacking within interventions. Furthermore, several countries, including Germany, have not equally adopted the concept yet. Therefore, the goal of the present study protocol is to describe the development and evaluation approach of a PL intervention ("PLACE") for children in grades three and four within the German all-day schooling system.

Methods

The physical literacy intervention cultivates explicit theory-content links and comprises 12 heterogeneous sessions (each 60-90 min in length). The study contains three different phases with two initial pilot studies and a subsequent main study. The two pilot studies take a mixed-methods character by drawing on quantitative pre-post-designs as well as interviews with children (in groups). In the main study, we will longitudinally compare the course of PL values (five outcome domains: physical, affective, cognitive, social, behavioral) between two study arms: school classes of children are either assigned to an intervention condition (regular physical education and health care plus PL intervention) or to a control condition (regular physical education and health care only).

Discussion

The findings of this study will provide evidence on how to structure a multicomponent intervention in Germany based on the PL concept. In summary, the results will report on the effectiveness of the intervention and, therefore, decide whether to scale-up the intervention.

Essential factors and key features in designing active aging programs and their outcomes: A narrative review study

With an increase in the older adult population, many countries have designed programs to promote active aging. Thus, knowledge of the factors and features of these programs is necessary to design a comprehensive active aging program. This study aimed to review the active aging programs focusing on the extraction of essential factors, key features, and outcomes of these programs. This narrative review was carried out to examine the conducted active aging programs. Through systematic searches of databases within the time limit of 2002-2021, articles were identified and assessed against inclusion and exclusion criteria. Using the findings, three sections were developed: (1) essential factors in designing programs that consist of older adults' participation, health maintenance and, promotion, leisure time, and technology use; (2) key features of the program, include affordability, voluntary participation, intergenerational consideration, social networks and government support, lifelong learning and teaching, cross-sectoral and inter-professional collaboration, and an enabling-supportive environment; (3) the program outcomes, include increasing awareness and knowledge, activities and participation, quality of life, life satisfaction in various psychological dimensions of well-being, and physical, mental, cognitive, and behavioral health in older adults. Some gaps were identified. Consequently, future planners are recommended to address older adults' sexual health, community culture, and gender in addition to other key features and essential factors in designing active aging programs to promote older adults' health.

Women's experiences with implementation of the physiologic birth program in Iran: a qualitative content analysis study

Introduction

Increased rate of caesarean section (CS) without medical indication is a global concern. According to the guidelines of the World Health Organization (WHO), the physiologic birth program is one of the strategies for reducing the rate of unnecessary caesarean sections. The aim of this study is to explain women's experiences with the implementation of the physiologic birth program in Iran.

Materials and methods

This study is a part of a mixed-method study involving 15 targeted semi-structured interviews individually conducted with women attending physiologic birth classes between January 2022 and June 2022. Interviews continued until data saturation was achieved. Data were analyzed using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman, using MAXQDA10 software.

Results

Analysis of the findings of the study led to the emergence of 2 themes, 4 categories, and 10 subcategories. The first theme was the positive experiences of the women ("satisfaction with pregnancy" and "making the childbirth process pleasant"), and the second theme was their negative experiences with physiologic birth ("challenges and limitation of physiologic birth program" and "lack of high-quality obstetric services in the public health system").

Conclusion

The results of this study showed that childbirth preparation classes reduced women's fear and stress and enhanced their positive attitude toward vaginal delivery by preparing them for childbirth. Also, effective communication with midwives and their support along with efficient implementation of physiologic birth techniques led to successful pain management and satisfaction with the birth process. Policymakers should implement strategies to remove limitations and make this program accessible to all women.

COVID-19's impact on a community-based physical activity program for adults with moderate-to-severe TBI

PURPOSE

Physical activity (PA) is proposed for long-term problems after traumatic brain injury (TBI) with mood, quality of life, and participation. However, COVID-19 mitigation strategies resulted in widespread closures of community-based fitness centres, including one housing a peer-assisted PA program (TBI-Health). The purpose of this study was to provide an in-depth exploration of COVID-19's impact on the TBI-Health program for adults with moderate-to-severe TBI and determine how their PA behaviours could be supported in the pandemic.

METHODS

Interpretative phenomenological analysis was employed to collect and analyze data from semi-structured Zoom-facilitated interviews with seven female and nine male adults with moderate-to-severe TBI (including program participants and mentors).

RESULTS

Three major themes were identified. Need for PA after TBI included specific benefits of PA after TBI and desire for an adapted PA program. Lasting Impacts of the TBI-Health Program identified belonging to the TBI-Health community, benefits, and knowledge transfer from the program. Resilience and Loss through the Pandemic comprised the repercussions of COVID-19, loss of the PA program, adapting PA to the pandemic, and resilience after TBI.

CONCLUSION

This study provides insights about impacts of participating in community-based peer-assisted PA programs after moderate-to-severe TBI and ways to support PA in unforeseen circumstances.IMPLICATIONS FOR REHABILITATIONOur community-based peer-assisted physical activity program for adults with moderate-to-severe traumatic brain injury (TBI) promoted a range of daily and social activities.Outdoor group-based physical activity programs provide physical activity and social opportunities for adults with moderate-to-severe TBI when indoor physical activity is restricted.Community-based peer-assisted physical activity programs can assist with posttraumatic growth after moderate-to-severe TBI.

Exploring a peer-based physical activity program in the community for adults with moderate-to-severe traumatic brain injury

PRIMARY OBJECTIVE

To explore the experiences of program mentors, participants, and employees involved in a peer-based physical activity (PA) program for adults with moderate-to-severe TBI, being piloted by a community fitness center, to develop the program as a measurable intervention.

RESEARCH DESIGN

We adopted an exploratory case study approach through an interpretivist paradigm, which focused on discovering realities about the peer-based PA program across the study participants' views, backgrounds, and experiences.

METHODS AND PROCEDURES

Semi-structured focus groups and individual interviews were conducted with nine adult program participants (3 peer mentors, 6 participants), and three program employees. Inductive content analysis was used to develop themes about their perceived experiences.

MAIN OUTCOMES AND RESULTS

44 open-codes were grouped into 10 subthemes and three final themes: 1) program impacts identified the importance of the program in daily life and resulting psychological, physical, and social outcomes; 2) program characteristics highlighted program leaders, accessibility, and social inclusion; 3) program sustainability included program adherence, benefits for the center, and the program's future.

CONCLUSIONS

Perceptions of program experiences and outcomes identified how peer-based PA for adults with moderate-to-severe TBI can lead to meaningful activities, functioning better, and buy-in from all parties. Implications for research and practice related to supporting health-related behaviors after TBI through group-based, autonomy-supporting approaches are discussed.

The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial

BACKGROUND

Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time.

OBJECTIVE

We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app.

METHODS

This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect.

RESULTS

A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ²₁=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=-1.98, 95% CI -3.78 to -0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=-1.38, 95% CI -1.98 to -0.78, P<.001), with a marginal increase at T3.

CONCLUSIONS

The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1159/000509129.

Effectiveness of interventions to contain out-of-pocket-expenditure in lower-middle income countries: A systematic review and synthesis

The extant literature on myriad interventional strategies to contain the adverse financial impacts of soaring out-of-pocket expenditures commands systematic auditing and knowledge synthesis. The purpose of this study is to answer these specific questions. What are the interventions present in lower-middle-income countries? How effective are those interventions in reducing the household's out-of-pocket expenditure? Are the studies suffering from any methodological bias? The imprints for this systematic review are obtained from Scopus, PubMed, Web of Science, ProQuest and CINAHL. These manuscripts are identified in full compliance with PRISMA guidelines. The documents identified have undergone quality assessment checks using the 'Effective Public Health Practice Project'. The review identified Interventions that are found to reduce out-of-pocket expenditure are patient educational programs, a combination of financial assistance, healthcare facility quality upgrade measures, and early disease detection strategies. However, these reductions represented marginal changes in the total health expenditure of patients. The role of non-health insurance interventions and the combination of health insurance and non-health insurance measures are highlighted. This review concludes by emphasising the need for further research to fill the knowledge gap by building on the suggestions put forward.

Adaptation of ACTivate Your Wellbeing, a Digital Health and Well-being Program for Young Persons: Co-design Approach

BACKGROUND

ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons' mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses.

OBJECTIVE

This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years.

METHODS

A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2.

RESULTS

Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention.

CONCLUSIONS

Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more.

The Effect of the Secret Agent Society Group Program on Parent-Teacher Agreement Regarding Children's Social Emotional Functioning

Differences in social-emotional processing and functioning characterize children with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Anxiety Disorders. These can contribute to difficulties forming friendships and secondary challenges such as academic underachievement, depression, and substance use in adolescence. To be optimally successful, interventions typically require parents and teachers to have a shared understanding of a child's social-emotional needs and use consistent support strategies across home and school environments. However, research is yet to examine the effect that clinic-based programs have on parent-teacher agreement regarding children's social-emotional functioning. To the authors' knowledge, this is the first published study to explore this. A sample of eighty-nine youth (aged 8 to 12 years) with ASD, ADHD, and/or an Anxiety Disorder participated in the Secret Agent Society Program. The Social Skills Questionnaire and Emotion Regulation and Social Skills Questionnaire were administered to parents and teachers at pre-program, post-program, and six-month follow-up. Parent-teacher agreement was assessed at each time point. Pearson Product Moment correlations and intraclass correlations indicated that parent-teacher agreement on the measures of children's social-emotional functioning improved over time. These findings suggest that clinic-based programs can contribute to key stakeholders developing a shared understanding of children's social-emotional needs. The implications of these findings and directions for future research are discussed.

A look back at 20 years of Program Evaluation

This article presents the reflections and insights of a graduate of Spalding's Psy.D. program who took the Program Evaluation course that is the focus of this special issue 20 years ago and has made Program Evaluation a central component of his career. Helpful elements of the course are noted as are ways that the course could have been strengthened then as well as now. Implications of these insights for the future of the course are also detailed.

The elderly's satisfaction with physical activity programs in senior welfare centers

Introduction

Healthcare for the aging population has become a crucial issue in South Korea to maintain the elderly's quality of life, and physical activity is of primary importance for older adults. This study evaluated the exercise characteristics and satisfaction of the elderly who participated in physical activity programs provided by senior welfare centers in South Korea.

Methods

We surveyed 266 participants to learn the characteristics of the elderly's exercise participation and their satisfaction with instructors, exercise programs, and facilities provided by senior welfare centers. A total of 263 copies were analyzed using the SPSS 23.0 statistical software.

Results and discussion

The top three physical activity programs that the elderly participated in senior welfare centers were dancing (25.3%), gymnastics (24.8%), and table tennis/badminton (13.2%). There were significant differences in respondents' satisfaction according to sex, education level, spouse, family type, and monthly income per household (p < 0.05). The elderly were satisfied with programs (4.183 ± 0.483), facilities (3.881 ± 0.483), and instructors (3.604 ± 0.483) in order. Also, this study shows that user satisfaction differs depending on the demographic characteristics (gender, education, marital status, family type, economic status) and the characteristics of the exercise participation of the elderly (exercise duration, participation period).

Conclusions

In conclusion, we presented the elderly's satisfaction with physical activity programs in senior welfare centers, suggesting that the elderly need physical activity programs according to their demographic and exercise characteristics.

Clinical and Psychosocial Outcomes Associated With a Tele-behavioral Health Platform for Families: Retrospective Study

BACKGROUND

The burden of pediatric mental illness in the United States has steadily worsened over the past decade. A recent increase in employer-sponsored behavioral health programs has focused on the needs of the general population. However, these programs do not provide the specialty mental health care required for children, adolescents, and their families.

OBJECTIVE

This study aimed to evaluate the effects of a technology-enabled pediatric and family behavioral health service on clinical outcomes among children and caregiver strain. The service is available to commercially insured populations and provides educational content; tele-behavioral health care, including coaching, therapy, and psychiatry; and care escalation and coordination.

METHODS

A retrospective cohort analysis of members using the service between February and September 2022 was conducted. Clinical outcomes for children and their caregivers were collected using the Pediatric Symptom Checklist-17 (PSC-17), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 8-item (PHQ-8), and Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). Rates of reliable improvement were determined by calculating the reliable change index for each outcome. Paired, 2-tailed t tests were used to evaluate significant changes in assessment scores at follow-up compared to baseline.

RESULTS

Of the 4139 participants who enrolled with the service, 48 (1.2%) were referred out for more intensive care, 2393 (57.8%) were referred to coaching, and 1698 (41%) were referred to therapy and psychiatry. Among the 703 members who completed the intervention and provided pre- and postintervention outcomes data, 386 (54.9%) used psychoeducational content, 345 (49.1%) received coaching, and 358 (50.9%) received therapy and psychiatry. In coaching, 75% (183/244) of participants showed reliable improvement on the PSC-17 total score, 72.5% (177/244) on the PSC-17 internalizing score, and 31.5% (105/333) on the CGSQ-SF7 total score (average improvement: PSC-17 total score, 3.37 points; P<.001; PSC-17 internalizing score, 1.58 points; P<.001; and CGSQ-SF7 total score, 1.02 points; P<.001). In therapy and psychiatry, 68.8% (232/337) of participants showed reliable improvement on the PSC-17 total score, 70.6% (238/337) on the PSC-17 internalizing score, 65.2% (219/336) on the CGSQ-SF7 total score, 70.7% (82/116) on the GAD-7 score, and 67.5% (77/114) on the PHQ-8 score (average improvement: PSC-17 total score, 3.16 points; P<.001; PSC-17 internalizing score, 1.66 points; P<.001; CGSQ-SF7 total score, 1.06 points; P<.001; GAD-7 score, 3.00 points; P<.001; and PHQ-8 score, 2.91 points; P<.001).

CONCLUSIONS

Tele-behavioral health offerings can be effective in improving caregiver strain and psychosocial functioning and depression and anxiety symptoms in a pediatric population. Moreover, these digital mental health offerings may provide a scalable solution to children and their families who lack access to essential pediatric mental health services.

Disparities of Health Program Information Systems in Indonesia: A Cross-Sectional Indonesian Health Facility Research 2019

Although a recording and reporting format for health centers already exists for Indonesia's standard information system, numerous health applications still need to meet the needs of each program. Therefore, this study aimed to demonstrate the potential disparities in information systems in the application and data collection of health programs among Indonesian community health centers (CHCs) based on provinces and regions. This cross-sectional research used data from 9831 CHCs from the Health Facilities Research 2019 (RIFASKES). Significance was assessed using a chi-square test and analysis of variance (ANOVA). The number of applications was depicted on a map using the spmap command with STATA version 14. It showed that region 2, which represented Java and Bali, was the best, followed by regions 1, which comprised Sumatra Island and its surroundings, and 3, Nusa Tenggara. The highest mean, equaling that of Java, was discovered in three provinces of region 1, namely, Jambi, Lampung, and Bangka Belitung. Furthermore, Papua and West Papua had less than 60% for all types of data-storage programs. Hence, there is a disparity in the health information system in Indonesia by province and region. The results of this analysis recommend future improvement of the CHCs' information systems.

The long-term effects of primary school-based obesity prevention interventions in children: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis investigate the long-term effects of primary school-based obesity prevention interventions on body-mass index (and z-scores), waist circumference (and z-scores) and weight status.

METHODS

Four databases were searched for studies from date of inception until June 8th, 2021. We included randomized controlled trials (RCT) and non-RCTs investigating effects ≥12 months post-intervention of primary school-based interventions with intervention duration ≥6 months and containing a diet and/or physical activity component on outcomes of interest. Articles were assessed on risk of bias and methodological quality by RoB2 and ROBINS-I. Meta-analysis was performed and results were narratively summarized. Evidence quality was assessed with GRADE.

RESULTS

Nineteen studies were included, 9 were pooled in a meta-analysis. No long-term effects were found on body-mass index (+0.06 kg/m² ; CI95% = -0.38, 0.50; I²  = 66%), body-mass index z-scores (-0.08; CI95% = -0.20, 0.04; I²  = 36%), and waist circumference (+0.57 cm; CI95% = -0.62, 1.75; I²  = 13%). Non-pooled studies reported mixed findings regarding long-term effects on body-mass index, body-mass index z-scores and weight status, and no effects on waist circumference and waist circumference z-scores. Evidence certainty was moderate to very low.

DISCUSSION

No clear evidence regarding long-term effects of primary school-based interventions on obesity-related outcomes was found. Recommendations for further research and policy are discussed. Prospero registration ID: CRD42021240446.

What Do Health Professionals and Parents Want as Part of an Online Childhood Obesity Prevention Program?

Background: There are limited evidence-based programs for children living in Queensland, Australia, who are at risk of overweight or obesity. Despite the known importance of prevention initiatives, an online, locally relevant program supporting sustainable health behaviors does not exist. This study aimed to understand the perspectives of parents/guardians and health professionals regarding important aspects of an online childhood obesity prevention program. Methods: This pragmatic, mixed-methods study was conducted from March to December 2020. Recruitment included participants from two groups involved with children aged 2-17 years, health professionals, and parents/guardians. Phase 1 involved dissemination of an online survey. Questions addressed program structure, content delivery (including nutrition, physical activity, and parenting practices), program evaluation, and information dissemination. Descriptive statistics were used to describe survey data to inform the delivery of Phase 2, where two focus groups further explored the topics. Thematic analysis was used to investigate the qualitative data. Results: Twenty-eight health professionals and 11 parents/guardians completed the survey, and 14 health professionals and 6 parents/guardians participated in the focus groups. Participants believed that the most beneficial approach would target younger children with family-based interventions, via a nontraditional structure. There was a strong preference for interactive content, gamification, and practical resources to translate knowledge into practice. Parents emphasized that there should be no assumption of basic knowledge, and that decision fatigue is a barrier to engagement. Conclusion: Participants provided clear direction regarding key aspects for future development of an online prevention program, highlighting the importance of codesign to tailor the program to identified needs.

Experience and Satisfaction with a Family-Based Physical Activity Intervention Using Activity Trackers and Apps: A Qualitative Study

Wearable activity trackers and smartphone apps have been shown to increase physical activity in children and adults. However, interventions using activity trackers and apps have rarely been tested in whole families. This study examined the experience and satisfaction with an activity tracker and app intervention (Step it Up Family) to increase physical activity in whole families. Telephone interviews were conducted with Queensland-based families (n = 19) who participated in the Step it Up Family intervention (N = 40, single-arm, pre/post feasibility study) in 2017/2018. Using commercial activity trackers combined with apps, the intervention included an introductory session, individual and family-level goal setting, self-monitoring, family step challenges, and weekly motivational text messages. Qualitative content analysis was conducted to identify themes, categories and sub-categories. In summary, parents reported that children were engaged with the activity tracker and app features to reach their daily step goals. Some technical difficulties were experienced with app navigation, syncing of activity tracker data, and tracker band discomfort. Although families liked that the weekly text messages reminded them to be active, they did not find them very motivating. Using text messages for physical activity motivation in families requires further testing. Overall, the intervention was well-received by families for increasing physical activity motivation.

Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study

BACKGROUND

Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR.

OBJECTIVE

We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre-Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program.

METHODS

In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed.

RESULTS

In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F_1,14=.026; P=.87) nor effect for time (F_1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study.

CONCLUSIONS

This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31855.

The Effects of Providing a Connected Scale in an App-Based Digital Health Program: Cross-sectional Examination

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The Effect of a Parent-Directed Program to Improve Infants' Motor Skills

Poor motor skills are associated with several factors that might delay children's development. Therefore, early programs to promote a child's motor development are essential. Within the first year of life, parents have a critical role in promoting their infant's motor development. However, little research has explored parent-directed programs that promote infant development in a Scandinavian context. This study aimed to evaluate the effectiveness of a parent-directed program to improve infant motor development.

METHODS

Parents of infants received a parent-directed program that included guidance from health visitors on ways to promote motor development, videos with motor development activities and a bag with related materials. Two municipalities in Denmark took part in the study (one intervention, one control). Health visitors in both municipalities measured the infants' age-appropriate motor skills once when the infants were between 9-11 months of age. A logistic regression model was used to analyze the data.

RESULTS

No difference was detected in motor development over time in the two municipalities regarding the proportion of children with age-appropriate motor skills.

CONCLUSIONS

A parent-directed program in which parents were guided to play and encourage motor development with their infant showed no effect on infants' age-appropriate motor skills at 9-11 months.

Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review

(1) Background: Effective communication among couples in which one has been diagnosed with cancer is critical to improve their psychosocial adaptation to cancer. The objective of this review was to explore the characteristics and measurement outcomes of existing couple-based communication interventions in the cancer context. (2) Methods: Eight electronic databases were searched from database initiation to August 2022 to identify eligible articles. Hand searching was also performed on the included articles' reference lists and authors. (3) Results: A total of 14 intervention studies were eligible to be included in this review. Cancer couples with distress or communication problems before intervention were more likely to benefit from the couple-based communication interventions. Positive outcomes were reported, including an improvement in relationship functioning (including mutual communication, intimacy, and relationship satisfaction) and individual functioning (including a decline of anxiety, depression and cancer-related concerns, and an increase in psychological adjustment and quality of life). (4) Conclusions: These findings supported the importance of improving mutual communication behaviors to promote cancer patient-spousal caregiver dyads' psychosocial adaptation to cancer. While most included studies were conducted in western countries and the sample size was relatively small, more research is warranted to develop more efficacious couple-based communication interventions.

Partnering With Residents on the Redesign of the Internal Medicine Resident Self-Evaluation Form

INTRODUCTION

The positive impact of resident-driven synthesis of assessment data has been associated with increased intrinsic motivation to learn and create an individualized strategy to improve performance. The objective of the study was to incorporate residents' recommendations for restructuring the self-assessment metric into a tool that will promote a well-organized and effective self-improvement plan.

MATERIALS AND METHODS

Residents and faculty collaborated on pre- and post-intervention questionnaires to assess the barriers to the timely completion of the current self-evaluation form and gather information on the tool's ability to stimulate the formation of concrete goals. The residents were also invited to provide their recommendations on the structure of the new tool and the educational domains that were assessed by the tool. The post-survey also evaluated the capacity of the proposed tool to guide residents in establishing specific goals.  Results: The new form is concise and more precise in assisting the learner in developing short-term and long-term goals and the strategies and resources to achieve them.  Discussion: Collaborating with the learners created an opportunity to address the faculty's and residents' most important concerns about the effectiveness of the metric.

CONCLUSION

 In a learner-centered model, resident participation is critical in designing/redesigning a practical self-assessment tool for residents in Internal Medicine.