Health behaviour change in cardiovascular disease prevention and management: meta-review of behaviour change techniques to affect self-regulation

The effects of Solution-Focused Brief Therapy on self-care and mental health among older adults at risk of coronary heart disease: A randomized controlled trial

This study tested the effectiveness of a nursing program developed based on Solution-Focused Brief Therapy (SFBT) in improving self-care skills and mental health among community-dwelling older adults at risk for coronary heart disease (CHD). A total of 120 older adults were randomly assigned to either an SFBT group or a control group. Participants' self-care ability, depressive symptoms, and anxiety at baseline and post-intervention were assessed using the Self-care Ability Scale for the Elderly (SASE), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS), respectively. The t-test, Mann-Whitney U, and chi-square tests were conducted for group comparisons. After 6 months of intervention, the intervention group had significantly higher self-concept, self-skills, self-care awareness, and health knowledge scores than the baseline and the control group (all P-values < 0.05). The intervention group had significantly lower depression and anxiety scores than the baseline and the control group (all P-values < 0.05). SFBT is effective in improving older adults' self-care and mental health and may be widely applied among older adults to prevent CHD and promote well-being in the future.

Exploring Aesthetic Outcomes and Complications in Auricular Reconstruction Utilising Autologous Cartilage: A Systematic Review and Narrative Synthesis

Auricular reconstruction remains a challenging procedure, requiring a high degree of manual dexterity and attention to detail in order to reconstruct the complex three-dimensional geometry of the ear successfully. Most techniques will rely on autologous cartilage for auricular framework fabrication, carrying a risk of donor and recipient site morbidity. The aim of this report is to investigate the complications and aesthetic outcomes associated with autologous cartilage harvest in auricular reconstruction. A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies for four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. The literature search identified 7171 articles. Filtering for relevance and duplication reduced the number of articles to 52. A total of 12,215 patients underwent auricular reconstruction utilising autologous cartilage. Indications included 11,696 patients due to microtia, 334 patients due to burns or trauma, 70 patients due to constricted ears, and 115 patients due to prominent ears. The most commonly reported donor site complications included chest wall deformities (n = 159). The most commonly reported recipient site complications included hypertrophic or keloid scars (n = 279), haematoma (n = 155), tissue expander exposure (n = 111), cartilage or framework exposure (n = 122), and cartilage framework deformation or resorption (n = 50). Although a challenging procedure, auricular reconstruction utilising autologous cartilage is possible. Exceptional aesthetic results can be achieved when performed by a skilled surgeon on appropriately selected individuals. However, the potential risks and complications associated with the procedure should be discussed with the patient and family beforehand.

Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators

Background

Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR.

Purpose

To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR.

Methods

Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation.

Results

The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior.

Conclusions

Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.

Study protocol for leaving care-A comparison study of implementation, change mechanisms and effectiveness of transition services for youth

INTRODUCTION

Youth placed in out-of-home care is a large and highly vulnerable group at high risk of negative developmental outcomes. Given the size and extent of negative developmental outcomes for youth placed in out-of-home care, interventions to help this vulnerable group navigate successfully towards independent living and promote wellbeing across a spectrum of outcome areas are needed. To date, there is a lack of such interventions, particularly in Sweden. Importing interventions from other societies and cultures is associated with difficulties. The aim of the research project is to implement, test, and evaluate interventions that have been recently developed in Swedish practice to close this gap.

METHODS

The project has an ambitious and complex data collection and analysis strategy using qualitative, quantitative, and multiple information methods (hybrid effectiveness-implementation study) over the course of two years. Both the implementation and effectiveness of the interventions will be evaluated. The recently developed My Choice-My Way! leaving care program for youth aged 15+ will be the primary focus of the project and will be compared to usual services.

CONCLUSIONS

The project has the potential to offer novel insights into how society can promote wellbeing across a spectrum of outcome areas for the high-risk group of youth transitioning from out-of-home care to independent living. As such, the project will have important implications for both research and practice.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05813197.

A systematic literature review and narrative synthesis on the use of autologous cartilage in the repair of orbital fractures

Introduction

Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures.

Methods

A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers.

Results

Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (n=23), infra-orbital para/anaesthesia (n=27), and enophthalmos (n=7). No failure of graft or donor site morbidity were observed in the studies.

Conclusion

Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.

Bisphosphonate therapy in the management of diffuse sclerosing osteomyelitis of the mandible: a systematic review and narrative synthesis

Background

Diffuse sclerosing osteomyelitis (DSO) affecting the mandible is an uncommon condition characterised by recurrent pain and functional disturbances. Traditional treatments involving antibiotics, steroids, and analgesics have generally yielded unsatisfactory results. Numerous articles have proposed the utilisation of bisphosphonate therapy as an alternative approach to achieve sustained symptom relief. This study aims to consolidate the available evidence on the effectiveness of bisphosphonate therapy in managing DSO.

Methods

A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies were devised, and studies were screened based on predefined inclusion and exclusion criteria.

Results

Ten articles met the eligibility criteria, encompassing a total of 135 patients diagnosed with DSO who received bisphosphonate treatment. All included studies consistently reported a reduction in pain levels and swelling, along with a decrease in the cumulative use of analgesics. The majority of patients reported long-lasting symptom improvement with bisphosphonate therapy. Notably, four studies documented improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Furthermore, six studies observed improvements in panoramic radiographs and cone beam computed tomography scans, with one publication describing two patients exhibiting near-normal bone architecture. Importantly, all studies reported the absence of long-term complications.

Conclusions

Bisphosphonate therapy emerges as a promising treatment modality for DSO, exhibiting efficacy in symptom alleviation and radiological enhancement while conferring lasting benefits. Nevertheless, further prospective studies are warranted to refine treatment protocols and substantiate these findings.

Cardiovascular disease risk communication and prevention: a meta-analysis

BACKGROUND AND AIMS

Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians. This review aimed to investigate the impact of CVD risk communication on patient-perceived CVD risk and changes in CVD risk factors.

METHODS

PubMed, Embase, and PsycINFO databases were searched from inception to 6 June 2023, supplemented by citation analysis. Randomized trials that compared any CVD risk communication strategy versus usual care were included. Paired reviewers independently screened the identified records and extracted the data; disagreements were resolved by a third author. The primary outcome was the accuracy of risk perception. Secondary outcomes were clinician-reported changes in CVD risk, psychological responses, intention to modify lifestyle, and self-reported changes in risk factors and clinician prescribing of preventive medicines.

RESULTS

Sixty-two trials were included. Accuracy of risk perception was higher among intervention participants (odds ratio = 2.31, 95% confidence interval = 1.63 to 3.27). A statistically significant improvement in overall CVD risk scores was found at 6-12 months (mean difference = -0.27, 95% confidence interval = -0.45 to -0.09). For primary prevention, risk communication significantly increased self-reported dietary modification (odds ratio = 1.50, 95% confidence interval = 1.21 to 1.86) with no increase in intention or actual changes in smoking cessation or physical activity. A significant impact on patients' intention to start preventive medication was found for primary and secondary prevention, with changes at follow-up for the primary prevention group.

CONCLUSIONS

In this systematic review and meta-analysis, communicating CVD risk information, regardless of the method, reduced the overall risk factors and enhanced patients' self-perceived risk. Communication of CVD risk to patients should be considered in routine consultations.

Evaluation of an application for the self-assessment of lifestyle behaviour in cardiac patients

BACKGROUND

Currently, no uniform, well-validated and comprehensive lifestyle behaviour self-assessment instrument exists for patients with cardiovascular disease.

PURPOSE

To evaluate the usability of a novel mobile application (LifeStyleScore) based on validated instruments for the assessment of cardiovascular risk behaviours. Secondly, the application's acceptance by healthcare professionals (HCPs) and its association with improved patient activation and lifestyle behaviour was evaluated.

METHODS

In this single-centre, non-randomised observational pilot study, patients with coronary artery disease or atrial fibrillation entering cardiac rehabilitation (CR) completed the LifeStyleScore application, the Patient Activation Measure (PAM-13®), and the System Usability Scale (SUS) during the CR intake and after CR completion. A focus group interview was performed with the HCPs involved.

RESULTS

We analysed 20 participants, 3 of whom were women, with a mean age of 61.9 ± 6.7 years. The LifeStyleScore application was rated with a SUS score above average (> 68) before (69.6 ± 13.4) and after CR (68.6 ± 15.1). All HCPs (n = 8) found the application usable. Patient activation did not increase significantly after CR compared with baseline (62.0 ± 8.6 versus 59.2 ± 9.5, respectively, p = 0.28) and only physical activity levels improved significantly (2.4 ± 0.7 (standardised score) at baseline, 2.8 ± 0.4 after CR, p = 0.04).

CONCLUSION

The LifeStyleScore application was found to be usable for patients receiving CR. Its use did not result in increased patient activation, and of the lifestyle behaviours only physical activity levels improved. Further research is needed to evaluate how such applications can be optimally incorporated in CR programmes.

Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?

BACKGROUND

Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown.

PURPOSE

To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity.

METHOD

The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants' (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0-10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group.

RESULTS

After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32-0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43-0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status.

CONCLUSION

Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.

'Super Rehab': can we achieve coronary artery disease regression? A feasibility study protocol

INTRODUCTION

Patients diagnosed with coronary artery disease (CAD) are currently treated with medications and lifestyle advice to reduce the likelihood of disease progression and risk of future major adverse cardiovascular events (MACE). Where obstructive disease is diagnosed, revascularisation may be considered to treat refractory symptoms. However, many patients with coexistent cardiovascular risk factors, particularly those with metabolic syndrome (MetS), remain at heightened risk of future MACE despite current management.Cardiac rehabilitation is offered to patients post-revascularisation, however, there is no definitive evidence demonstrating its benefit in a primary prevention setting. We propose that an intensive lifestyle intervention (Super Rehab, SR) incorporating high-intensity exercise, diet and behavioural change techniques may improve symptoms, outcomes, and enable CAD regression.This study aims to examine the feasibility of delivering a multicentre randomised controlled trial (RCT) testing SR for patients with CAD, in a primary prevention setting.

METHODS AND ANALYSIS

This is a multicentre randomised controlled feasibility study of SR versus usual care in patients with CAD. The study aims to recruit 50 participants aged 18-75 across two centres. Feasibility will be assessed against rates of recruitment, retention and, in the intervention arm, attendance and adherence to SR. Qualitative interviews will explore trial experiences of study participants and practitioners. Variance of change in CAD across both arms of the study (assessed with serial CT coronary angiography) will inform the design and power of a future, multi-centre RCT.

ETHICS AND DISSEMINATION

Ethics approval was granted by South West-Frenchay Research Ethics Committee (reference: 21/SW/0153, 18 January 2022). Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications.

TRIAL REGISTRATION NUMBER

ISRCTN14603929.

A hybrid type 2 effectiveness-implementation design to evaluate a community-based, heart-healthy intervention for women of low socio-economic status

BACKGROUND

Women of low socioeconomic status continue to experience a disproportionate burden of cardiovascular disease. To respond to their unique needs, we adapted the intervention and implementation strategy of an effective theory-based psychoeducational intervention for improving heart-healthy behaviors. Study aims were to evaluate implementation (i.e., reach, fidelity, acceptability, appropriateness) and effectiveness (i.e., perceived stress, common physical symptoms in primary care, physical activity, diet) of the adapted program we called mySTEPS.

METHOD

We used a hybrid type 2 effectiveness-implementation approach. To evaluate implementation, we conducted a process evaluation using data from research records, observation rubrics, and pre-/post-intervention surveys. To evaluate potential effectiveness, we used a one-group, pre-/post-test design with three, sequential offerings (16 weeks each) in unique settings, used standardized, quantitative measures at 8 weeks post-intervention, and calculated effect sizes.

RESULTS

Forty-two women were included in the evaluation. For reach, 66 % and 61 % of participants attended adequate numbers of educational and coaching sessions. Supporting fidelity of delivery, nurse implementers addressed 85-98 % of required criteria. Supporting fidelity of receipt, participants' pre- to post- knowledge scores increased and other scores revealed that nurse-implementers had interacted supportively throughout mySTEPS. Participants rated the acceptability and appropriateness of components positively. Effect-sizes revealed moderate decreases in stress, moderate increases in physical activity, and modest decreases in the number of physical symptoms. Dietary scores did not change.

CONCLUSIONS

The effectiveness and implementation of mySTEPS were positive overall. After strengthening the dietary component, more extensive evaluation of mySTEPS can be conducted to explain mechanisms of action.

MESH HEADINGS

Health behavior, prevention, self-determination theory, self-regulation theory, cardiovascular diseases, implementation strategies.

Ist Stress am Arbeitsplatz ein Thema für den kardiologischen Alltag? Evidenz, Erkennung und Therapie aversiver Stressbedingungen im Arbeitsumfeld

In modernen Industriegesellschaften verbringen die Menschen die aktivste Zeit ihres Lebens in beruflicher Umgebung, die damit weitgehend Alltag und Lebensqualität bestimmt. Immer mehr verschwimmen die Grenzen zwischen Privatem und Beruflichem. Neben „klassischem“ Arbeitsstress – häufig definiert als Missverhältnis von hohen Anforderungen bei gleichzeitig geringen Entscheidungsmöglichkeiten oder als Missverhältnis zwischen Arbeitseinsatz und Belohnung – gehören u. a. Überarbeitung, Mobbing und Arbeitsplatzverlust sowie negative Arbeitsplatzbedingungen zu den Belastungen, die seelische und körperliche gesundheitliche Probleme auslösen können. Evidenz aus Megastudien mit > 100000 Teilnehmern belegt die Bedeutung von Arbeitsstress als Risikofaktor (RF) für Hypertonie, Schlafstörungen und Depressionen. Unter Arbeitsstress werden häufig gesundheitsgefährdende Verhaltensweisen als Kompensationsversuche eingesetzt. Andauernder Arbeitsstress wird damit zu einem signifikanten RF für ischämische Herzerkrankungen, zerebrovaskuläre Ereignisse und Diabetes mellitus. Arbeitsstress sollte daher in der kardiologischen Praxis exploriert werden. Grundzüge einer auf Arbeitsstress fokussierten Gesprächsführung für den Alltagseinsatz werden vorgestellt.

Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis: a qualitative study within the VIPVIZA trial

OBJECTIVES, SETTING AND SUBJECTS

Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice.

DESIGN

In-depth interviews with 14 individuals were analysed with qualitative content analysis.

RESULTS

Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants' descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process.

CONCLUSIONS

The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care. Trial registration: ClinicalTrials.gov identifier: NCT01849575, registration 8 May 2013.Key pointsAtherosclerosis screening and pictorial-based risk communication have the potential to contribute to more effective CVD prevention strategies.Risk messages on atherosclerosis status were perceived as clear, accurate, reliable and emotionally engaging.An interplay between efficacy beliefs and emotional reactions facilitated behavioural change.Patients' understanding of CVD risk is important for shared decision-making and of relevance for non-adherence to preventive guidelines.

Testing motivational and self-regulatory mechanisms of action on device-measured physical activity in the context of a weight loss maintenance digital intervention: A secondary analysis of the NoHoW trial

BACKGROUND

To date, few digital behavior change interventions for weight loss maintenance focusing on long-term physical activity promotion have used a sound intervention design grounded on a logic model underpinned by behavior change theories. The current study is a secondary analysis of the weight loss maintenance NoHoW trial and investigated putative mediators of device-measured long-term physical activity levels (six to 12 months) in the context of a digital intervention.

METHODS

A subsample of 766 participants (Age = 46.2 ± 11.4 years; 69.1% female; original NoHoW sample: 1627 participants) completed all questionnaires on motivational and self-regulatory variables and had all device-measured physical activity data available for zero, six and 12 months. We examined the direct and indirect effects of Virtual Care Climate on post intervention changes in moderate-to-vigorous physical activity and number of steps (six to 12 months) through changes in the theory-driven motivational and self-regulatory mechanisms of action during the intervention period (zero to six months), as conceptualized in the logic model.

RESULTS

Model 1 tested the mediation processes on Steps and presented a poor fit to the data. Model 2 tested mediation processes on moderate-to-vigorous physical activity and presented poor fit to the data. Simplified models were also tested considering the autonomous motivation and the controlled motivation variables independently. These changes yielded good results and both models presented very good fit to the data for both outcome variables. Percentage of explained variance was negligible for all models. No direct or indirect effects were found from Virtual Care Climate to long term change in outcomes. Indirect effects occurred only between the sequential paths of the theory-driven mediators.

CONCLUSION

This was one of the first attempts to test a serial mediation model considering psychological mechanisms of change and device-measured physical activity in a 12-month longitudinal trial. The model explained a small proportion of variance in post intervention changes in physical activity. We found different pathways of influence on theory-driven motivational and self-regulatory mechanisms but limited evidence that these constructs impacted on actual behavior change. New approaches to test these relationships are needed. Challenges and several alternatives are discussed.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN88405328. Registered December 16, 2016, https://www.isrctn.com/ISRCTN88405328.

Development of eHealth-Based Behavior Change Support for Young Adults Using the Nine Principles Framework

Implementing behavior strategies into nutrition research requires consideration. The Nine Principles framework was used to develop an eHealth behavior change support (BCS) program to enhance young adults' adherence to (1) eating healthily and (2) recording dietary intake when participating in a randomized control trial. The Theory of Planned Behavior and qualitative focus group data informed a 10-week pilot of the BCS delivered on Facebook and texts. The BCS appeared to support optimal dietary recording and maintained dietary behaviors, suggesting using a framework underpinned by theory and user-centered design may be a promising avenue to enhance adherence in randomized control trials.

Concepts from behavioral theories can guide clinicians in coaching for behavior change

OBJECTIVES

Many patients do not engage in health behaviors that can control common, chronic illnesses. Clinicians have opportunities to promote health behaviors yet may lack skills for coaching effectively about health behaviors. Our aims are to: present definitions of coaching, propose concepts for coaching about behavior change from two theories, share theory-guided research on behavior change relevant to ambulatory care settings, and delineate how concepts from these theories can guide coaching.

METHODS

In our discussion, we explain how two behavioral theories are complementary and applicable to coaching, present empirical support for these theories, and describe applications of these concepts for practice.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Self-determination theory can guide clinicians in how to interact with patients to meet patients' psychological needs, to promote health behaviors, and subsequent health status. Self-regulation theory can guide coaches in what concepts to address for behavior change. These complementary theories have been supported in rigorous research with adult populations in ambulatory care settings.

Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis

BACKGROUND

Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans.

OBJECTIVE

The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF.

METHODS

Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data.

RESULTS

Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language.

CONCLUSIONS

We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features.

The Impact of a Place-Tailored Digital Health App Promoting Exercise Classes on African American Women's Physical Activity and Obesity: Simulation Study

BACKGROUND

The increasing prevalence of smartphone apps to help people find different services raises the question of whether apps to help people find physical activity (PA) locations would help better prevent and control having overweight or obesity.

OBJECTIVE

The aim of this paper is to determine and quantify the potential impact of a digital health intervention for African American women prior to allocating financial resources toward implementation.

METHODS

We developed our Virtual Population Obesity Prevention, agent-based model of Washington, DC, to simulate the impact of a place-tailored digital health app that provides information about free recreation center classes on PA, BMI, and overweight and obesity prevalence among African American women.

RESULTS

When the app is introduced at the beginning of the simulation, with app engagement at 25% (eg, 25% [41,839/167,356] of women aware of the app; 25% [10,460/41,839] of those aware downloading the app; and 25% [2615/10,460] of those who download it receiving regular push notifications), and a 25% (25/100) baseline probability to exercise (eg, without the app), there are no statistically significant increases in PA levels or decreases in BMI or obesity prevalence over 5 years across the population. When 50% (83,678/167,356) of women are aware of the app; 58.23% (48,725/83,678) of those who are aware download it; and 55% (26,799/48,725) of those who download it receive regular push notifications, in line with existing studies on app usage, introducing the app on average increases PA and decreases weight or obesity prevalence, though the changes are not statistically significant. When app engagement increased to 75% (125,517/167,356) of women who were aware, 75% (94,138/125,517) of those who were aware downloading it, and 75% (70,603/94,138) of those who downloaded it opting into the app's push notifications, there were statistically significant changes in PA participation, minutes of PA and obesity prevalence.

CONCLUSIONS

Our study shows that a digital health app that helps identify recreation center classes does not result in substantive population-wide health effects at lower levels of app engagement. For the app to result in statistically significant increases in PA and reductions in obesity prevalence over 5 years, there needs to be at least 75% (125,517/167,356) of women aware of the app, 75% (94,138/125,517) of those aware of the app download it, and 75% (70,603/94,138) of those who download it opt into push notifications. Nevertheless, the app cannot fully overcome lack of access to recreation centers; therefore, public health administrators as well as parks and recreation agencies might consider incorporating this type of technology into multilevel interventions that also target the built environment and other social determinants of health.

A systematic literature review and narrative synthesis on the risk factors for developing affective disorders in open lower-limb fracture patients

Background

Despite the advancements made in the management of the physical complications of open lower-limb fractures, few studies have been performed which investigate the association of such injuries with affective disorders. The complications resulting from this injury may result in significant psychological distress.

Aim

To evaluate the risk factors associated with the development of affective disorders, in patients with open lower-limb fractures.

Methods

A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. A comprehensive literature search was performed to gather relevant papers. Two independent reviewers screened titles and abstracts according to the inclusion and exclusion criteria.

Results

2488 were screened according to the inclusion and exclusion criteria resulting in seven articles eligible for inclusion. Of the seven articles, two assessed for PTSD, one assessed for depression and PTSD concurrently, two assessed for anxiety and depression concurrently, and two assessed for psychological distress. With the exception of two studies, open lower limb fracture patients were included with other lower-limb injuries in their analysis. Furthermore, not all variables were available in all included studies. Risk factors identified included post-operative pain, mechanism and severity of injury, age of patient, social support and social deprivation.

Conclusions

Further studies are required within this area. However, addressing risk factors such as pain management, poor social support and inappropriate coping mechanisms, may reduce the incidence of affective disorders by equipping patients with necessary psychosocial resources.

•

Patients with strong social support have, in general, a lower risk of depression and psychological distress.

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Poverty is a risk factor in general for psychological distress.

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Negative affect may play an important role in determining physical function during the recovery period.

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In most patients, symptoms of psychological distress improve over time.

•

Not all patients may display symptoms of psychological distress immediately post-injury.

Social cognition theories and behavior change in COVID-19: A conceptual review

The COVID-19 pandemic has had unprecedented health, economic, and social consequences worldwide. Although contact reductions and wearing face coverings have reduced infection rates, and vaccines have reduced illness severity, emergence of new variants of the coronavirus that causes COVID-19, and the shift from pandemic to endemic patterns of infection, highlights the importance of ongoing preventive behavior adherence to manage future outbreaks. Research applying social cognition theories may assist in explaining variance in these behaviors and inform the development of efficacious behavior change interventions to promote adherence. In the present article, we summarize research applying these theories to identify modifiable determinants of COVID-19 preventive behaviors and the mechanisms involved, and their utility in informing interventions. We identify limitations of these applications (e.g., overreliance on correlational data, lack of long-term behavioral follow-up), and suggest how they can be addressed. We demonstrate the virtue of augmenting theories with additional constructs (e.g., moral norms, anticipated regret) and processes (e.g., multiple action phases, automatic processes) to provide comprehensive, parsimonious behavioral explanations. We also outline how the theories contribute to testing mechanisms of action of behavioral interventions. Finally, we recommend future studies applying these theories to inform and test interventions to promote COVID-19 preventive behavior adherence.

Self-Regulation and Students Well-Being: A Systematic Review 2010–2020

In recent years, there has been particular interest in studying the relationship between student self-regulation and variables such as students’ well-being, satisfaction, and school engagement. Although in other fields such as healthcare, self-regulation in different areas seems to influence individuals’ well-being, this is not so well established in the educational arena. We performed a systematic search of research articles published between 2010 and 2020 which explored the relationships between self-regulation and student well-being. The present article presents a report of a systematic review of 14 research articles. The analysis showed that some executive functions and self-regulation strategies employed in the learning process, and some self-regulatory deficits are significantly associated with different dimensions of student well-being.

Association Between Prospective Registration and Quality of Systematic Reviews in Type 2 Diabetes Mellitus: A Meta-epidemiological Study

Background: We sought to investigate the methodological and reporting quality of published systematic reviews describing randomized controlled trials in type 2 diabetes mellitus and analyze their association with status of protocol registration.

Methods: We searched the PubMed database and identified non-Cochrane systematic reviews, with or without meta-analysis, reporting on type 2 diabetes mellitus and published between 2005 and 2018. We then randomly selected 20% of these reviews in each year, and performed methodological and reporting quality assessment using the Assessment of Multiple Systematic Review 2 (AMSTAR-2) checklist and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We also conducted regression analyses to explore the association between characteristics of systematic reviews and AMSTAR-2 or PRISMA scores.

Results: A total of 238 systematic reviews, including 33 registered and 205 non-registered articles, met the inclusion criteria and were subsequently reviewed. Analysis indicated an increase in both registered rates and quality of systematic reviews in type 2 diabetes mellitus over the recent years. With regards to methodological and reporting quality, we found higher scores in registered, relative to non-registered reviews (AMSTAR-2 mean score: 18.0 vs. 14.5, P = 0.000; PRISMA mean score: 20.4 vs. 17.6, P = 0.000). AMSTAR-2 and PRISMA scores were associated with registration status, country of the first author, and statistical results, whereas the proportion of discussing publication bias and reporting funding sources were <40% for both registered and non-registered systematic reviews.

Conclusions: Methodological and reporting quality of systematic reviews in type 2 diabetes mellitus indicates an improvement in the recent years. However, the overall quality remains low, necessitating further improvement. Future studies are expected to pay more attention to prospective registration, description of publication bias and reporting of funding sources.

Efficient Automated Disease Diagnosis Using Machine Learning Models

Recently, many researchers have designed various automated diagnosis models using various supervised learning models. An early diagnosis of disease may control the death rate due to these diseases. In this paper, an efficient automated disease diagnosis model is designed using the machine learning models. In this paper, we have selected three critical diseases such as coronavirus, heart disease, and diabetes. In the proposed model, the data are entered into an android app, the analysis is then performed in a real-time database using a pretrained machine learning model which was trained on the same dataset and deployed in firebase, and finally, the disease detection result is shown in the android app. Logistic regression is used to carry out computation for prediction. Early detection can help in identifying the risk of coronavirus, heart disease, and diabetes. Comparative analysis indicates that the proposed model can help doctors to give timely medications for treatment.

Substance use prevention interventions for children and young people in Sub-Saharan Africa: A systematic review

BACKGROUND

Different techniques and approaches have been used for substance use prevention worldwide. No reviews of prevention interventions in Africa exist; hence this study aimed to systematically review interventions undertaken in Sub-Saharan Africa to prevent substance use in children and young people.

METHODS

MEDLINE, EMBASE, Cochrane Central, CAB, PsycINFO, CINAHL, SCOPUS, ERIC, and Web of Science databases were searched. Studies were included if they evaluated a substance use prevention intervention for children and young people in a Sub-Saharan African Country between 2000 and 2020. A narrative synthesis was used to explore and describe the data.

RESULTS

Eighteen studies, mostly from South Africa, were included. Most (10/18) of the interventions were school-based. Only two of the included studies were considered having a strong quality concerning the risk of bias, and some studies poorly reported the interventions. School-based interventions, although successful in improving knowledge, had little or no effects on substance use. Overall, most studies that reported a statistically significant reduction in substance use-related outcomes were brief interventions, individual-focused, and involved participants who were already exposed to substance use. These were mostly delivered by trained professionals using motivational interviewing or cognitive behavioural therapy or both.

CONCLUSION

School-based programs present an opportunity for substance use prevention efforts in the Sub-Saharan region in Africa. Such programs may benefit from an improved focus on individual students. There is a need for improving the quality of design, implementation, and reporting of substance use interventions within the region.

Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings

Background: Primary care organizations are well-suited to help patients change their unhealthy behaviors. Evidence shows that risk communication and self-monitoring of behavior are is an effective strategy practitioners can use to promote health behavior change with their patients. In order for this evidence to be actionable, it is important to understand how patients would like this information to be communicated and to operationalize the self-monitoring resources. The objective of this study was to co-create resources that encourage behavior change based on the scientific evidence and from patients with lived experiences.

Materials and Methods: Twenty-seven individuals who participated in a smoking cessation program and engaged in at least one other unhealthy behavior joined one of two engagement events. Each event was 3 h in duration and consisted of two exercises that provided support to participants in reaching a consensus about the types of messages they would like to receive from their practitioner as well as self-monitoring resources they would prefer to use. The first exercise followed an adapted version of the Consensus Methodology developed by the Institute of Cultural Affairs Canada, while the second exercise was in accordance to the Nominal Group Technique.

Results: Participants' preference was to have practitioners convey messages to promote health behavior change that include positive affirmation and to monitor all their health behaviors using a single self-reported tracking sheet.

Conclusions: This paper features the use of engagement events to reflect upon and identify potential resources that treatment seeking smokers prefer to receive while attempting to modify unhealthy behaviors. These resources can be used by health care providers in primary care settings to support health promotion interventions and assist their patients to increase their likelihood of adopting positive changes to risk behaviors.

Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology

Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.

Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review

BACKGROUND

Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients.

OBJECTIVE

This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support.

METHODS

A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data.

RESULTS

A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality-based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery.

CONCLUSIONS

These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.

The Role of Exercise in Management of Mental Health Disorders: An Integrative Review

A large and growing body of evidence suggests that physical activity (PA) may hold therapeutic promise in the management of mental health disorders. Most evidence linking PA to mental health outcomes has focused on the effects of aerobic exercise training on depression, although a growing body of work supports the efficacy of both aerobic and resistance exercise paradigms in the treatment of anxiety and post-traumatic stress disorder. Despite abundant evidence linking PA and mental health, use of exercise training as a mental health treatment remains limited due to three important sources of uncertainty: (a) large individual differences in response to exercise treatment within multiple mental health domains; (b) the critical importance of sustained PA engagement, not always achieved, for therapeutic benefit; and (c) disagreement regarding the relative importance of putative therapeutic mechanisms. Our review of treatment data on exercise interventions and mental health outcomes focuses primarily on depression and anxiety within a health neuroscience framework. Within this conceptual framework, neurobiological and behavioral mechanisms may have additiveor synergistic influences on key cognitive and behavioral processes that influence mental health outcomes. We therefore highlight sources of treatment heterogeneity by integrating the critical influences of (a) neurobiological mechanisms enhancing neuroplasticity and (b) behavioral learning of self-regulatory skills. Understanding the interrelationships between dynamic neurobiological and behavioral mechanisms may help inform personalized mental health treatments and clarify why, and for whom, exercise improves mental health outcomes. The review concludes with recommendations for future studies leveraging individual differences to refine treatment approaches to optimize mental health benefits.

Patients' perceptions of self-management of high blood pressure in three low- and middle-income countries: findings from the BPMONITOR study

Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient-physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.

Effects of socio-structural variables in the theory of planned behavior: a mediation model in multiple samples and behaviors

Objective: Observed variation in health behavior may be attributable to socio-structural variables that represent inequality. We tested the hypothesis that variability related to socio-structural variables may be linked to variation in social cognition determinants of health behavior. A proposed model in which effects of socio-structural variables (age, education level, gender, income) on health behavior participation was mediated by social cognition constructs was tested. Design: Model effects were tested in correlational datasets (k = 13) in different health behaviors, populations, and contexts. Samples included self-report measures of age, highest attained education level, gender, and net household income, and constructs from the theory of planned behavior (attitude, subjective norms, perceived behavioral control, intention). Ten samples provided follow-up self-reports of health behavior. Results: Path analyses supported sample-specific indirect effects of gender and age on health behavior with comparatively few income and education level effects. Meta-analytic structural equation modeling indicated consistent indirect and total effects of gender on intentions and health behavior through social cognition constructs, and a total effect of education level on behavior. Conclusion: Results provide support for the proposed mechanism by which socio-structural variables relate to health behavior. Replication in larger samples and meta-analytic synthesis across multiple health behavior studies is warranted.