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Nyamathi AM, Salem BE, Gelberg L, Garfin DR, Wolitsky-Taylor K, Shin SS, Yu Z, Hudson A, Yadav K, Clarke R, Alikhani M, van Cise E, Lee D. Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness. Stress Health 2023. [PMID: 38146789 DOI: 10.1002/smi.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 12/27/2023]
Abstract
People experiencing homelessness report increased exposure to traumatic life events and higher rates of depression, anxiety, and post-traumatic stress disorder as compared with the general population. Heart rate variability-biofeedback (HRV-BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV-BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV-BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (n = 40) were randomized to either the HRV-BF or an active HP control group and received eight weekly, 30-min sessions over two months, delivered by a nurse-led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8-week session, and/or 2-month follow-up. All intervention sessions were completed by 90% (36/40) of participants. Both the HRV-BF and HP interventions showed significant increases in HRV from baseline to 2-month follow-up, with no significant difference between the intervention groups. The HRV-BF programme revealed a somewhat greater, although non-significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV-BF and HP intervention.
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Affiliation(s)
- Adeline M Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Benissa E Salem
- School of Nursing, University of California, Los Angeles, California, USA
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Dana Rose Garfin
- Community Health Sciences/Fielding School of Public Health, Los Angeles, California, USA
| | - Kate Wolitsky-Taylor
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Zhaoxia Yu
- Department of Statistics, School of Information and Computer Sciences, University of California, Irvine, California, USA
| | | | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Richard Clarke
- Office of Research, University of California, Irvine, California, USA
| | - Mitra Alikhani
- School of Nursing, University of California, Los Angeles, California, USA
| | | | - Darlene Lee
- Susan Samueli Integrative Health Institute, University of California, Irvine, California, USA
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Nyamathi A, Salem BE, Lee D, Yu Z, Hudson A, Saab S, Shin SS, Jones-Patten A, Yadav K, Alikhani M, Clarke R, Chang A, White K, Gelberg L. Exploratory assessment: Nurse-led community health worker delivered HCV intervention for people experiencing homelessness. Public Health Nurs 2023; 40:641-654. [PMID: 37132164 PMCID: PMC10524682 DOI: 10.1111/phn.13204] [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: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Getting and maintaining Hepatitis C Virus (HCV) cure is challenging among people experiencing homelessness (PEH) as a result of critical social determinants of health such as unstable housing, mental health disorders, and drug and alcohol use. OBJECTIVES The purpose of this exploratory pilot study was to compare a registered nurse/community health worker (RN/CHW)-led HCV intervention tailored for PEH, "I am HCV Free," with a clinic-based standard of care (cbSOC) for treating HCV. Efficacy was measured by sustained virological response at 12 weeks after stopping antivirals (SVR12), and improvement in mental health, drug and alcohol use, and access to healthcare. METHODS An exploratory randomized controlled trial design was used to assign PEH recruited from partner sites in the Skid Row Area of Los Angeles, California, to the RN/CHW or cbSOC programs. All received direct-acting antivirals. The RN/CHW group received directly observed therapy in community-based settings, incentives for taking HCV medications, and wrap-around services, including connection to additional healthcare services, housing support, and referral to other community services. For all PEH, drug and alcohol use and mental health symptoms were measured at month 2 or 3 and 5 or 6 follow-up, depending on HCV medication type, while SVR12 was measured at month 5 or 6 follow-up. RESULTS Among PEH in the RN/CHW group, 75% (3 of 4) completed SVR12 and all three attained undetectable viral load. This was compared with 66.7% (n = 4 of 6) of the cbSOC group who completed SVR12; all four attained undetectable viral load. The RN/CHW group, as compared to the cbSOC, also showed greater improvements in mental health, and significant improvement in drug use, and access to healthcare services. DISCUSSION While this study shows significant improvements in drug use and health service access among the RN/-CHW group, the sample size of the study limits the validity and generalizability of the results. Further studies using larger sample sizes are necessitated.
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Affiliation(s)
- Adeline Nyamathi
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Benissa E Salem
- University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Darlene Lee
- University of California, Irvine, Susan Samueli Integrative Health Institute, Irvine, California
| | - Zhaoxia Yu
- University of California, Irvine, Department of Statistics, School of Information and Computer Sciences, Irvine, California
| | | | - Sammy Saab
- Adult Liver Transplant Program, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sanghyuk S Shin
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | | | - Kartik Yadav
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Mitra Alikhani
- University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Richard Clarke
- University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, California
| | - Alicia Chang
- Los Angeles County Department of Public Health, Community Field Services, Inglewood, California
| | - Kathryn White
- Los Angeles Christian Health Centers, Los Angeles, California
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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