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Sanchez-Ortuno MM, Pecune F, Coelho J, Micoulaud-Franchi JA, Salles N, Auriacombe M, Serre F, Levavasseur Y, de Sevin E, Sagaspe P, Philip P. Predictors of users' adherence to a fully automated digital intervention to manage insomnia complaints. J Am Med Inform Assoc 2023; 30:1934-1942. [PMID: 37672004 PMCID: PMC10654843 DOI: 10.1093/jamia/ocad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/04/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE Fully automated digital interventions show promise for disseminating evidence-based strategies to manage insomnia complaints. However, an important concept often overlooked concerns the extent to which users adopt the recommendations provided in these programs into their daily lives. Our objectives were evaluating users' adherence to the behavioral recommendations provided by an app, and exploring whether users' perceptions of the app had an impact on their adherence behavior. MATERIAL AND METHODS Case series study of individuals completing a fully automated insomnia management program, conducted by a virtual agent, during December 2020 to September 2022. Primary outcome was self-reported adherence to the behavioral recommendations provided. Perceptions of the app and of the virtual agent were measured with the Acceptability E-Scale and ECA-Trust Questionnaire. Insomnia was evaluated with the Insomnia Severity Index at baseline (phase 1), after 7 days of sleep monitoring (phase 2) and post-intervention (phase 3). RESULTS A total of 824 users were included, 62.7% female, mean age 51.85 (±12.55) years. Of them, 32.7% reported having followed at least one recommendation. Users' trust in the virtual agent and acceptance of the app were related to a pre-intervention effect in insomnia severity (phase 2). In turn, larger pre-intervention improvements predicted better adherence. Mediational analyses showed that higher levels of trust in the virtual agent and better acceptance of the app exerted statistically significant positive effects on adherence (β = 0.007, 95% CI, 0.001-0.017 and β = 0.003, 95% CI 0.0004-0.008, respectively). DISCUSSION Users' adherence is motivated by positive perceptions of the app's features and pre-intervention improvements. CONCLUSIONS Determinants of adherence should be assessed, and targeted, to increase the impact of fully automated digital interventions.
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Affiliation(s)
- Maria Montserrat Sanchez-Ortuno
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- School of Nursing, Department of Nursing, University of Murcia, 30120 Murcia, Spain
| | - Florian Pecune
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
| | - Julien Coelho
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Sleep Medicine Service, University Hospital, 33076 Bordeaux, France
| | - Jean Arthur Micoulaud-Franchi
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Sleep Medicine Service, University Hospital, 33076 Bordeaux, France
| | - Nathalie Salles
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Department of Clinical Gerontology, University Hospital, 33076 Bordeaux, France
| | - Marc Auriacombe
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Addiction Treatment Services, Charles Perrens Hospital, 33076 Bordeaux, France
| | - Fuschia Serre
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Addiction Treatment Services, Charles Perrens Hospital, 33076 Bordeaux, France
| | - Yannick Levavasseur
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
| | - Etienne de Sevin
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
| | - Patricia Sagaspe
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Sleep Medicine Service, University Hospital, 33076 Bordeaux, France
| | - Pierre Philip
- SANPSY, UMR 6033, University of Bordeaux, 33076 Bordeaux, France
- CNRS, SANPSY, UMR 6033, 33076 Bordeaux, France
- Sleep Medicine Service, University Hospital, 33076 Bordeaux, France
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Complexity theory in the management of patients with musculoskeletal pain. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:563-573. [PMID: 36511673 PMCID: PMC9776532 DOI: 10.7705/biomedica.6440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 12/14/2022]
Abstract
Nonlinear systems are not susceptible to research with a reductionist approach. In this sense, the complexity theory provides an alternative approach to quantify the importance of contextual factors in patients with musculoskeletal pain. The use of positive (placebo) or negative (nocebo) contextual factors in the therapeutic setting could largely account for the non-specific component of treatment efficacy, directly affecting the quality of patients’ health-related outcomes (e.g., pain, disability, or satisfaction). In recent years, there has been a better understanding of the effects of contextual factors. However, the knowledge and awareness of them is limited and heterogeneous among physical therapists, reducing their translational value in the field of physiotherapy.
The purpose of this essay is to describe the management of patients with musculoskeletal pain from the complexity theory perspective.
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The Mediating Effect of Life Satisfaction on Relation between Perceived Physical Attractiveness and Health-Promoting Lifestyle in Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157784. [PMID: 34360074 PMCID: PMC8345598 DOI: 10.3390/ijerph18157784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 01/07/2023]
Abstract
Physical attraction, perceived in terms of satisfaction with body image and interpersonal relationships, can be an essential factor in an individual's emotional and social well-being. However, empirical studies that link physical attraction to health are limited. This study explores the mediating effect of life satisfaction on the relation between perceived physical attractiveness and lifestyle of health, making an effort to reach an optimal state in physical, emotional, social, spiritual, and intellectual domains in Korean adults. Four hundred fifty-nine adults in a community setting participated in this cross-sectional study. The results showed positive associations among physical attractiveness, life satisfaction, and health-promoting lifestyle after adjusting for age, gender, marital status, education, and job status. Life satisfaction partially mediated the relationship between perceived physical attractiveness and a higher lifestyle of health (z = 2.80, p = 0.005). For health promotion and disease prevention, positive psychology can be a suitable strategy. Physical attractiveness and life satisfaction can be important keys to maintain health-promoting lifestyle behavior.
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Card KG, Lachowsky NJ, Armstrong HL, Cui Z, Wang L, Sereda P, Jollimore J, Patterson TL, Corneil T, Hogg RS, Roth EA, Moore DM. The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men. Addict Behav 2018; 82:158-165. [PMID: 29533847 PMCID: PMC5894339 DOI: 10.1016/j.addbeh.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/22/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other. METHODS We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged ≥16 years, recruited in Metro Vancouver using respondent driven sampling. Hospital Anxiety and Depression Scale scores assessed mental health. Alcohol Use Disorder Identification Test scores assessed alcohol disorders. Poly-use of multiple drug types (e.g., stimulants, sedatives, opiates, hallucinogens) was assessed over the previous six months. RESULTS Among 719 predominantly white (68.0%), gay-identified (80.7%) GBM, alcohol use was not associated with increased prevalence of high-risk sex. Controlling for demographic factors and partner number, an interaction between polysubstance use and depressive symptoms revealed that the combined effects were additively associated with increased odds for high-risk sex. Mediation models showed that polysubstance use partially mediated the relationship between depressive symptoms and high-risk sex. CONCLUSION An interaction effect between polysubstance use (defined by using 3 or more substances in the past six months) and depressive symptoms (defined by HADS scores) revealed that the combination of these factors was associated with increased risk for high-risk sex - supporting a syndemic understanding of the production of HIV risk.
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Affiliation(s)
- Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada; Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community Based Research Centre for Gay Men's Health, Vancouver, British Columbia, Canada
| | | | - Trevor Corneil
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Rivas-Suárez SR, Águila-Vázquez J, Suárez-Rodríguez B, Vázquez-León L, Casanova-Giral M, Morales-Morales R, Rodríguez-Martín BC. Exploring the Effectiveness of External Use of Bach Flower Remedies on Carpal Tunnel Syndrome: A Pilot Study. J Evid Based Complementary Altern Med 2017; 22:18-24. [PMID: 26456628 PMCID: PMC5871196 DOI: 10.1177/2156587215610705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A randomized, pilot, placebo-controlled clinical trial was conducted with the aim of evaluating the effectiveness of a cream based on Bach flower remedies (BFR) on symptoms and signs of carpal tunnel syndrome. METHODS Forty-three patients with mild to moderate carpal tunnel syndrome during their "waiting" time for surgical option were randomized into 3 parallel groups: Placebo (n = 14), blinded BFR (n = 16), and nonblinded BFR (n = 13). These groups were treated during 21 days with topical placebo or a cream based on BFR. RESULTS Significant improvements were observed on self-reported symptom severity and pain intensity favorable to BFR groups with large effect sizes (η2partial > 0.40). In addition, all signs observed during the clinical exam showed significant improvements among the groups as well as symptoms of pain, night pain, and tingling, also with large effect sizes (φ > 0.5). Finally, there were significant differences between the blinded and nonblinded BFR groups for signs and pain registered in clinical exam but not in self-reports. CONCLUSION The proposed BFR cream could be an effective intervention in the management of mild and moderate carpal tunnel syndrome, reducing the severity symptoms and providing pain relief.
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Affiliation(s)
- Saira R Rivas-Suárez
- Medical University "Serafín Ruíz de Zárate Ruíz" of Villa Clara, Santa Clara, Cuba
- University Hospital "Arnaldo Milián Castro," Santa Clara, Cuba
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Kelly G, Hauck YL, Bayes S, Hardwick T. Women’s Perceptions of Contributory Factors for Not Achieving a Vaginal Birth After Cesarean (VBAC). INTERNATIONAL JOURNAL OF CHILDBIRTH 2013. [DOI: 10.1891/2156-5287.3.2.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND:With cesarean rates around the world escalating, concern is growing around why women wanting a vaginal birth after cesarean (VBAC) are not achieving their goal.AIM:To gain an understanding of women’s perceptions of factors they felt contributed to not achieving a VBAC.SETTING AND PARTICIPANTS:Fifteen women were interviewed following a nonelective repeat cesarean section (NERCS). They had attended a Western Australian midwifery-led service, next birth after cesarean (NBAC), and labored but were not successful in achieving a VBAC because of reasons around delayed progress. Interview transcripts were analyzed using Colaizzi’s method of thematic analysis.FINDINGS:Five themes emerged: “Tentative commitment with lingering doubts,” “My body failed me,” “Compromised by a longer than tolerable labor,” “Unable to effectively self-advocate in a climate of power struggling and poor support,” and “The inflexibility of hospital processes.” The final theme included two subthemes: “Restrictive policies” on labor and use of the cardiotocography, “The CTG.”CONCLUSIONS:When labor did not progress as envisaged and hospital processes adversely affected how women were supported, women’s doubts around being able to achieve a VBAC were reinforced with a NERCS. Maternity services need to ensure clinical practice reflects best evidence while assuring staff are supportive of women’s choice.
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