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Kukafka R, Hawkes RE, French DP. How the Behavior Change Content of a Nationally Implemented Digital Diabetes Prevention Program Is Understood and Used by Participants: Qualitative Study of Fidelity of Receipt and Enactment. J Med Internet Res 2023; 25:e41214. [PMID: 36630165 PMCID: PMC9878374 DOI: 10.2196/41214] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The National Health Service Digital Diabetes Prevention Programme (NHS-DDPP) is a program for adults in England at risk of developing type 2 diabetes mellitus (T2DM). It is based on NHS England specifications that stipulate specific behavior change techniques (BCTs), that is, active ingredients to produce behavior change to target diet and physical activity. Now rolled out nationally, the NHS-DDPP is being delivered by 4 independent providers as a 9-month intervention via apps, educational material, and remote health coaching. To optimize effectiveness, participants need to be able to understand and use behavior change content (eg, goal setting and problem solving) of an intervention delivered to them digitally. Previous research has shown that people benefit from support to aid the understanding and use of BCTs. OBJECTIVE The objectives of this qualitative study were to evaluate how participants in the NHS-DDPP understand and use BCT content, investigate how participants describe the role of health coaches in supporting their behavior change, and examine how the understanding and use of behavior change content of the NHS-DDPP varies across providers. METHODS In total, 45 service users were interviewed twice by telephone at 2 to 4 months into, and at the end of, the program. Topics included participants' understanding and use of key BCTs to support self-regulation (eg, goal setting) and the support they received via the program. Transcripts were analyzed thematically, informed by the framework method. RESULTS Participants described their understanding and use of some behavior change content of the program as straightforward: use of BCTs (eg, self-monitoring of behavior) delivered digitally via provider apps. Participants valued the role of health coaches in supporting their behavior change through the emotional support they offered and their direct role in delivery and application of some BCTs (eg, problem solving) to their specific circumstances. Participants expressed frustration over the lack of monitoring or feedback regarding their T2DM risk within the program. Variations in the understanding and use of behavior change content of the NHS-DDPP were present across provider programs. CONCLUSIONS Health coaches' support in delivery of key components of the program seems to be pivotal. To improve the understanding and use of BCTs in digital interventions, it is important to consider routes of delivery that offer additional interactive human support. Understanding of some self-regulatory BCTs may benefit from this support more than others; thus, identifying the optimal mode of delivery for behavior change content is a priority for future research. The NHS-DDPP could be improved by explicitly setting out the need for health coaches to support understanding of some self-regulatory BCT content such as problem solving in the service specification and amending the discharge process so that knowledge of any change in T2DM risk is available to participants.
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Affiliation(s)
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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Nurse J. Pigmented Remedies: The Pharmacy of Colour in Early Modern Europe. Can Bull Med Hist 2021; 38:S93-S117. [PMID: 34739770 DOI: 10.3138/cbmh.474-102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article will examine pigments recently identified in an unpublished conservation survey at the Wellcome Collection that included two 17th-century medical manuscripts. These pigments, which were drawn from plant and mineral products, served a dual purpose based on their medicinal and pigmented properties. An exploration of how these pigments were used (and why) by a range of practitioners - including apothecaries, physicians, "kitchen physicians," and artisans - reveals the importance of colour throughout early modern Europe. The persistence of traditional medical theories is revealed by examining evidence across an extensive period covering the 16th to the 18th century. Receipt books, medical treatises, and health guides are contrasted with artisanal texts reflecting the blurring of boundaries between the worlds of medicine and art. Modern analysis by conservators of colour used in medieval and early modern texts is crucial to the preservation of pigments but also provides a deeper understanding of what and how pigmented products were used in the period and, ultimately, informs our current understandings of early modern life and medicine.
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Affiliation(s)
- Julia Nurse
- Julia Nurse - Collections and Research, Wellcome Trust, London, United Kingdom
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He X, Chen W, Tang D, Wen F, Zhang P, Li Q. Factors related to the receipt of adjuvant therapy among patients with gastric cancer in Western China. Eur J Cancer Care (Engl) 2019; 28:e13012. [PMID: 30748055 DOI: 10.1111/ecc.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 10/23/2018] [Accepted: 01/17/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Adjuvant therapy following curative resection has been shown to be associated with significant survival benefits in patients with gastric cancer (GC); however, this treatment is not available to some patients. The aim was to investigate factors associated with the receipt of adjuvant therapy among GC patients. METHODS This is a retrospective study including patients with stage IB-IIIC gastric adenocarcinoma who underwent curative resection between November 2010 and July 2014. Patients were identified using a database from West China Hospital, Sichuan University. Univariate and multivariable analyses examined factors associated with adjuvant therapy receipt. RESULTS A total of 1,476 patients were included. Among these, 852 patients were eligible, with 157 patients not receiving adjuvant therapy. Age, education, income, residence, medical insurance, employment status and visiting an oncologist were independently associated with adjuvant therapy receipt by univariate analysis. After adjustment for other factors, medical insurance (p = 0.005), employment status (p = 0.008) and visiting an oncologist (p < 0.001) remained significantly correlated, and income was near the threshold of a significant difference (p = 0.050). CONCLUSION Our study indicates that disparities do exist in determining the receipt of adjuvant therapy in GC patients according to income, insurance and employment status, and highlight the importance of visiting an oncologist postoperatively.
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Affiliation(s)
- Xiaofeng He
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Wenwen Chen
- Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Dan Tang
- Department of Medical Oncology, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Feng Wen
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pengfei Zhang
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiu Li
- Department of Medical Oncology, Division of Abdominal Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Chen CH, Wu MS, Hsu WY, Chen YM, Hsu CC, Hsiung CA, Wu IC. Determinants of influenza vaccination in older adults: A nationwide community-based study in Taiwan. Geriatr Gerontol Int 2017; 17:2396-2402. [PMID: 28753227 DOI: 10.1111/ggi.13088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/13/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
Abstract
AIMS Influenza vaccination (InVa) is an effective measure for preventing influenza infection, which is a major cause of morbidity and mortality in older adults. However, the determinants of InVa remain unclear. METHODS The present study included 4756 adults aged 55 years and older who completed the baseline examination of the Healthy Aging Longitudinal Study in Taiwan. During the examination, each participant received assessments of InVa status. Comprehensive assessments of sociodemographic (age, sex, education level, marital status, living alone and occupation) and health-related factors (chronic diseases, smoking status, alcohol intake, physical activities, cognitive status and physical performance) were also carried out. The InVa rate was defined as the number of participants who reported receiving free InVa divided by the total number of candidates for free InVa. Multinomial logistic regression analysis was applied to investigate the sociodemographic and health-related determinants of InVa status. RESULTS The coverage rate of InVa was 44.8% (2130/4756). Older age (adjusted odds ratio [OR; >75 years vs <65 years] 7.72, 95% CI 6.26-9.52), multiple chronic diseases (OR [≥2 vs 0)] 1.31, 95% CI 1.10-1.65) and physical activity (OR [yes vs no] 1.43, 95% CI 1.23-1.64) were positively associated with receiving InVa. A current smoking status (OR 0.67, 95% CI 0.55-0.82) was negatively associated with receiving InVa. CONCLUSIONS Older adults who received InVa differed from non-receivers in multiple sociodemographic and health-related characteristics. These findings support continual efforts to improve the InVa coverage rate in vulnerable populations. Geriatr Gerontol Int 2017; 17: 2396-2402.
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Affiliation(s)
- Chang-Hua Chen
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Ming-Shiang Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Yu Hsu
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Min Chen
- Department of Pharmacy, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
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Bischoff-Grethe A, Connolly CG, Jordan SJ, Brown GG, Paulus MP, Tapert SF, Heaton RK, Woods SP, Grant I. Altered reward expectancy in individuals with recent methamphetamine dependence. J Psychopharmacol 2017; 31:17-30. [PMID: 27649775 PMCID: PMC5225125 DOI: 10.1177/0269881116668590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chronic methamphetamine use may lead to changes in reward-related function of the ventral striatum and caudate nucleus. Whether methamphetamine-dependent individuals show heightened reactivity to positively valenced stimuli (i.e. positive reinforcement mechanisms), or an exaggerated response to negatively valenced stimuli (i.e. driven by negative reinforcement mechanisms) remains unclear. This study investigated neural functioning of expectancy and receipt for gains and losses in adults with (METH+) and without (METH-) histories of methamphetamine dependence. METHODS Participants (17 METH+; 23 METH-) performed a probabilistic feedback expectancy task during blood-oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI). Participants were given visual cues probabilistically associated with monetary gain, loss, or neutral outcomes. General linear models examined the BOLD response to: (1) anticipation of gains and losses, and (2) gain and loss monetary outcomes. RESULTS METH+ had less BOLD response to loss anticipation than METH- in the ventral striatum and posterior caudate. METH+ also showed more BOLD response to loss outcomes than to gain outcomes in the anterior and posterior caudate, whereas METH- did not show differential responses to the valence of outcomes. DISCUSSION METH+ individuals showed attenuated neural response to anticipated gains and losses, but their response to loss outcomes was greater than to gain outcomes. A decreased response to loss anticipation, along with a greater response to loss outcomes, suggests an altered ability to evaluate future risks and benefits based upon prior experience, which may underlie suboptimal decision-making in METH+ individuals that increases the likelihood of risky behavior.
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Affiliation(s)
| | - Colm G Connolly
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Stephan J Jordan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Gregory G Brown
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Martin P Paulus
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Steven P Woods
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
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