Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions

A service evaluation of psychoeducation groups for patients with functional seizures

This study presents a mixed method service evaluation of the Non-Epileptic Attack Disorder (NEAD) service psychoeducation groups, which were developed to provide timely care to patients diagnosed with functional seizures at the Newcastle upon Tyne Hospitals NHS Foundation trust (NUTH). The study aimed to conduct a content analysis of the interventions and identify behaviour change techniques utilised, as well evaluating the outcome data collected from Step 1 and Step 2 psychoeducation sessions from a year period (February 2023-January 2024). 13 Behaviour Change Techniques (BCTs) were identified in the Step 1 psychoeducation session, that targeted four intervention functions and 15 BCTs were identified across the Step 2 psychoeducation sessions, that also targeted four intervention functions. The quantitative findings demonstrated that the Step 1 psychoeducation sessions significantly improved patient and non-patient understanding of functional seizures, and the Step 2 psychoeducation sessions significantly improved patient understanding of functional seizures, self-efficacy and distress. Qualitative findings from the Step 1 patient data produced three themes: Affirmation, Improving Understanding and Heterogeneous Needs. Additionally, qualitative findings from the Step 1 non-patient data produced three themes: Resources, Improving Understanding and Satisfaction With Content. Overall, the study concludes that the NEAD service is meeting the needs of patients and non-patients who attend the NEAD psychoeducation sessions at NUTH. The findings were discussed in the context of their strengths and limitations, and recommendations were made for further research.

Dose-response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial

BACKGROUND

The inability to appropriately react to balance perturbations is a common cause of falls. Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention. However, its dose-response relationship, feasibility, and acceptability remain to be determined among older adults at risk of falling. The FEATURE study aimed to compare the efficacy of two treadmill PBT protocols with different session numbers to improve reactive balance, and to evaluate their feasibility and acceptability in this population.

METHODS

In this randomized controlled pilot trial, 36 older adults at risk of falling were allocated to receive either six (6PBT) or two treadmill PBT sessions (2PBT). Reactive balance in standing (Stepping Threshold Test [STT]) and walking (Dynamic Stepping Threshold Test [DSTT]) was assessed as primary outcome at baseline (T1), post-intervention (T2), and 6-week follow-up (T3). Secondary outcomes included measures on physical, psychological, and cognitive functioning. Feasibility was assessed via PBT adherence, planned perturbations completed, and adverse events; acceptability via questionnaire. Between-group changes over time were compared using repeated-measures analyses of variance with Bonferroni-corrected post-hoc tests. Data analyses followed the intention-to-treat principle.

RESULTS

A significant time effect was observed for the DSTT (p = 0.008), with both groups significantly improving from T1 to T2 (ps < 0.01). A significant interaction effect (p = 0.027) revealed that only the 6PBT group maintained these improvements (T1 vs. T3: p < 0.001) and scored significantly higher than the 2PBT group at T3 (p = 0.015). No significant interaction effects were found for the STT or any secondary outcome, but improvements over time were observed for dynamic balance, gait capacity, functional mobility, physical activity, concerns about falling, and executive functioning (time effects: ps < 0.05). PBT adherence, planned perturbations completed, and acceptability were high in both groups, with no significant between-group differences. No intervention-related serious adverse events were reported.

CONCLUSIONS

Findings suggest that a low number of treadmill PBT sessions can lead to task-specific improvements in reactive balance during walking, with a higher practice dose enhancing sustainability. Treadmill PBT appears feasible and well-accepted among older adults at risk of falling, regardless of sessions received.

TRIAL REGISTRATION

DRKS00030805 ; prospectively registered December 14, 2022.

Acceptability of the Expert Standard for Oral Health Care in Elderly Patients Among Nursing Staff in German Hospitals and Care Facilities - a protocol for cross-sectional study

BACKGROUND

The aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in elderly individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard "Promoting Oral Health in Nursing" was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice.

OBJECTIVE

To assess the acceptability of the expert standard among nursing staff providing care for elderly individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, Care Rationed or Missed (CROM), and the standard's acceptability.

METHODS

This quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic TFA (Theoretical Framework of Acceptability), a questionnaire to measure acceptability of interventions across seven domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile (OHLP) and competence in mouth care using the questionnaire developed by the German Network for Quality Development in Nursing (DNQP). Barriers to implementation will be evaluated according to the Acute Care Nurses' Questionnaire on Oral Hygiene and CROM using the oral care related question from Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of firstly calculating mean acceptability with 95% confidence interval for each recommended intervention of the expert standard. Secondly, repeated measures ANOVA are used to examine mean differences of acceptability between these interventions. Thirdly, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi square tests of independence are used to compare CROM with already published rates in German speaking countries.

RESULTS

Results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. Data collection will commence in June 2025 and is expected to be completed by October 2025.

CONCLUSIONS

This study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in the elderly. By focusing on acceptability as a prerequisite for implementation, the study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes.

CLINICALTRIAL

Use of a generic Paediatric Patient Reported Outcome Measure (P-PROM) in Routine hospital Outpatient Care for Kids (ROCK): A qualitative exploration of adolescent, caregiver and service provider perspectives (P-PROM ROCK Phase 1)

PURPOSE

To explore patient, caregiver, and service provider perspectives on the implementation of a generic Paediatric Patient Reported Outcome Measure (P-PROM), their perspectives on the EQ-5D-Y-5L, and to consider how these insights can be used to co-design routine use of EQ-5D-Y-5L in paediatric outpatient care.

METHODS

Individual semi-structured interviews were conducted with adolescent patients, caregivers, and providers (allied health, nurses, doctors) who had provided or received outpatient care at The Royal Children's Hospital, Australia. Interview transcripts were analysed using framework analysis and subsequent themes were mapped to an acceptability framework.

RESULTS

Interviews were conducted in June and July 2023 with six service providers, five caregivers and three adolescent patients. Despite service provider concerns that generic P-PROMs may be too broad; all were open to their use. Participants did not see value in patients simply completing a generic P-PROM; it was emphasised that such information needed to be used and responded to. Participants were largely supportive of using the EQ-5D-Y-5L in clinical care, although some were concerned about the short recall period and negative framing. Displaying EQ-5D-Y-5L responses by item was preferred by participants. These different perspectives were summarised into enablers and barriers of acceptability.

CONCLUSIONS

Perspectives gathered from this study highlight that generic P-PROMs, such as EQ-5D-Y-5L, may have potential for use in paediatric outpatient care. However, to have a meaningful impact, careful consideration is needed regarding implementation. Results have informed co-design of the P-PROM ROCK Program.

The Swedish theoretical framework of acceptability questionnaire: translation, cultural adaptation, and descriptive pilot evaluation

BACKGROUND

Successful complex healthcare interventions require evaluations of acceptability. Acceptability is suggested to impact intervention implementation, uptake, adherence, intended outcomes, and overall effectiveness. Namely, interventions that are not acceptable to those delivering or receiving them may hinder the key components from being delivered as intended or the recipients from engaging with the interventions as required. However, no validated questionnaire that evaluates acceptability was found in Swedish.

METHODS

We translated the generic Theoretical Framework of Acceptability questionnaire into Swedish, culturally adapted it, and conducted a descriptive pilot evaluation of its psychometric properties. The process involved iterative translation and cultural adaptation following the COSMIN checklist. The questionnaire underwent a forward-backwards translation and an evaluation of face and content validity by an expert panel of researchers. Thereafter, the face validity and comprehensibility of the translated version were evaluated using cognitive interviews and the think-aloud technique; this process was carried out in two rounds of interviews, each with a lay panel of healthcare professionals comprising intervention deliverers and receivers. Lastly, the Swedish version was piloted on 16 Swedish healthcare professionals who had received an educational intervention.

RESULTS

The evaluations of face validity, comprehensibility, and the descriptive pilot evaluation indicate a successful translation, cultural adoption, and usability of the Theoretical Framework of Acceptability questionnaire. The evaluation of content validity showed some problems with the validity of the scale and 7 out of 10 items was below threshold values.

CONCLUSIONS

Overall, the Swedish Theoretical Framework of Acceptability questionnaire seems like a useful brief screening tool for the acceptability of healthcare interventions. The translation process revealed unresolved issues with content validity, possibly explained by the previously reported lack of consensus on the meaning of 'acceptability'. Complementing free text answers or interviews could strengthen the understanding of any unclear questionnaire elements. Our findings support the generic Theoretical Framework of Acceptability questionnaire developers' recommendations of continued cognitive interviewing and psychometric evaluations in any new setting. In addition, we recommend cross-measure validation between the existing acceptability questionnaires to help further refining the measurement of acceptability.

Continuous Glucose Monitoring in the Management of Medication in Care Home Residents with Type 2 Diabetes (eDMED): A Protocol for a Feasibility Study

AIMS

Overprescribing is common in older adults with diabetes, potentially leading to hospitalisation and reduced quality of life. Additionally, diabetes care in older adults is often complicated by multiple interacting conditions and cognitive impairment, resulting in challenging self-management. Although evidence suggests that de-intensification of medications is safe in older adults, there are no data evaluating glucose ranges during this process.

METHODS

eDMED is a 12-week feasibility study including 49 adults, aged ≥ 65 years with type 2 diabetes and residing in care homes. All eligible participants will receive medication de-intensification and continuous glucose monitoring (CGM). Primary healthcare professionals (HCPs) will undergo structured training on a de-intensification algorithm and CGM, while care home staff will receive tailored education on diabetes management and CGM application to ensure safe and effective implementation.

PLANNED OUTCOMES

The primary outcome is the percentage of participants achieving a composite of > 50% time in range and < 1% time below range at 12 weeks, measured via CGM. Secondary outcomes include trends in time above and below range (quantified by level of hyper- or hypoglycaemia), change in quality of life (EQ-5D-5L), percentage of data captured to indicate adherence to the CGM and the acceptability of the intervention to participants, their consultees and carers (Theoretical Framework of Acceptability questionnaire).

TRIAL REGISTRATION

International Clinical Trials Registry Platform (ID: ISRCTN 69024008).

Promoting substance use stigma resistance through an automated text message intervention (project RESTART): Outcomes of a pilot feasibility trial

BACKGROUND

Stigma in people who use drugs predicts treatment engagement, psychosocial health, and overdose, yet there are few evidence-based interventions to support people who use drugs in managing and coping with substance-related stigma and even fewer for people in active use. mHealth is one option to engage this hard-to-reach population.

METHODS

Premised on the theory of stigma resistance, this mixed-methods study explored the feasibility, acceptability, and preliminary effectiveness of Project RESTART, a four-week, automated text message intervention for rural-dwelling people who use drugs (n = 30) using a one-group pre-post design. The study recruited participants from syringe service programs and by word-of-mouth.

RESULTS

Key outcomes included high retention (90 %), message engagement (median responses: 4, interquartile range: 1-17), acceptability (mean item score: 3.55, standard deviation: 0.34, range: 1-4), and preliminary effectiveness in the main outcomes (Cohen's d: stigma resistance (0.56), self-stigma (0.50)). Results were corroborated in sub-sample follow-up interviews (n = 13).

CONCLUSION

These promising findings suggest text messaging is a feasible and acceptable modality for delivering stigma education and coping resources. Effectiveness should be established in a full-scale randomized controlled trial. This trial was registered at ClinicalTrials.gov on February 20, 2024 (NCT06281548).

Implementation of a Quality Improvement Tool "Recover25" to Guide the Care of Patients Experiencing Prolonged Critical Illness: A Mixed-Method Feasibility Study

OBJECTIVES

Few quality improvement (QI) tools are specifically designed to manage the care of patients experiencing prolonged critical illness. This risks omissions in care. To determine the implementation feasibility and clinician acceptability of our QI tool "Recover25," we focused on actionable processes of care for patients with an ICU stay of over 7 days and their families.

DESIGN

Parallel convergent mixed-methods feasibility study conducted between February 2024 and May 2024.

SETTING

A mixed ICU in London, United Kingdom.

SUBJECTS

Patients with an ICU stay of more than 7 days, and the staff who care for them.

INTERVENTIONS

We invited representatives of all ICU professions to a weekly QI round.

MEASUREMENTS AND MAIN RESULTS

We recorded the time completed Recover25, the amount and type of actions generated following Recover25 use (i.e., what new care activities did it prompt), and the number and profession of staff attending each round. We administered the Theoretical Framework of Acceptability (TFA) questionnaire and conducted semi-structured clinician interviews. We calculated means (sds) or interquartile ranges (IQRs) (percentiles) of time to complete and a number of actions generated. We analyzed and integrated qualitative data using framework analysis informed by the TFA. "Recover 25" was used 34 times (65%) of 52 opportunities with 26 patients. Median (IQR) Recover25 completion time was 9.75 minutes (8.2-14.9 min) with a completion rate of 96% (89-100%). Recover25 usage prompted a median of 1 (IQR) (1-2) new action. There was a mean of 4 (sd 2) interprofessional team members attending each QI round. Nineteen clinicians completed 33 TFA questionnaires and 11 interviews. Recover25 was perceived as acceptable, with 94% reporting it aligned with their principles of good care, 85% perceiving it as a coherent intervention, and 67% perceiving it was effective. Interview data showed participants valued the emphasis on person-centered care and highlighted ways to improve implementation.

CONCLUSION

Recover25 was perceived as feasible to implement and acceptable by staff. Further work is needed to understand the effects on patient experience and outcomes.

Acceptability of implementing a communication board for mechanically ventilated patients in intensive care units: A cross-sectional substudy of the intervention arm of a pilot randomised controlled trial

BACKGROUND

Communication boards are a low-technology tool used to facilitate interactions with mechanically ventilated patients in intensive care units (ICUs). Research on the acceptability of communication boards in resource-limited intensive care settings is lacking.

AIM

The aim of this study was to assess patients' and nurses' experienced acceptability of implementing a communication board in Sri Lankan ICUs.

DESIGN

This was a cross-sectional substudy of the intervention group patients and nurses who participated in a pilot randomised controlled trial that assessed the feasibility of implementing a communication board in two ICUs in one Sri Lankan hospital.

METHODS

In the parent trial conscious, ventilated adult ICU patients were recruited. This substudy included all patients in the intervention group in the parent trial and ICU nurses who used the communication board. Sekhon's generic acceptability questionnaire, adapted and translated into Sinhala, was administered to both patients and nurses. The questionnaire comprised eight items; seven items represented the seven constructs of the framework (possible scores ranging from 7 to 35), and a single item measured general acceptability. Descriptive and inferential statistics were used to analyse the data. Additionally, nurses were asked three open-ended questions regarding their views on using the communication board, and data were analysed using content analysis.

RESULTS

Of the 123 patients screened in the parent trial, 60 met the inclusion criteria and were randomised, with 30 randomly allocated to the intervention group. In total, 30 patients and 50 nurses completed the survey (response rate: 100%). Both patients and nurses rated all items positively except "burden". Patient and nurse total mean scores for the seven items, excluding the single-item general acceptability, were 27.5 (standard deviation: 2.6) and 27.2 (standard deviation: 2.2), respectively. Patients and nurses both scored high on the single-item general acceptability, with a median (interquartile range) of 4.0 (4.0-5.0) and 4.0 (4.0-4.0), respectively. Two patient items and five nurse items significantly correlated with the single-item general acceptability. Two categories, (i) drivers for using the communication board and (ii) obstacles to communication board use, were found through content analysis.

CONCLUSION

This substudy demonstrated that the communication board was acceptable to both patients and nurses despite its perceived "burden".

Patient-Rated Acceptability of Automatic Palliative Care Referral: A Prospective Cohort Study

CONTEXT

Timely palliative care can alleviate distress after diagnosis of an incurable cancer. However, late referrals to palliative care continue, reflecting various provider and patient barriers.

OBJECTIVES

To determine patient/caregiver-reported acceptability of a phone call offering a supportive and palliative care (SPC) consultation without requiring oncologist referral.

METHODS

Two SPC nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients to offer an SPC consultation. Eligibility: >18 years, newly diagnosed/suspected stage IV nonsmall cell lung cancer, and completed first oncologist visit. Patients/caregivers were surveyed about the acceptability of the phone call offering SPC consultation, using Sekhon's Framework of Acceptability domains.

RESULTS

Among 113 patients screened, 81 patients/caregivers were contacted and offered an SPC consultation; 72% accepted the consultation. Of 48 patients/caregivers surveyed, 94% rated overall acceptability of the call somewhat/completely acceptable; 6% rated it neither acceptable nor unacceptable. Within specific acceptability domains, 95% were comfortable receiving the call; 92% understood why they received the call; 87% found the call valuable; 70% found the call helpful; 66% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97% thought the call required little physical/emotional effort and were confident in their ability to participate (i.e., to ask questions/make decisions).

CONCLUSION

These unsolicited phone calls offering SPC consultation were highly acceptable to patients/caregivers, and most agreed to the consultation. Implementing routine calls offering SPC consultation may be a timely alternative to awaiting conventional oncologist referral.

Reorganization of work schedules for better distribution of work demands in home health care - a feasibility study

BACKGROUND

Given the home health care industry's growth, increasing demand for workers, and complex patient care needs, investigating initiatives to maintain home health care workers' health and ability to work is crucial. This study aims to assess the feasibility of an organizational intervention for equal distribution of physical and psychosocial work demands among home health care aides.

METHOD

We conducted a 7-week quasi-experimental feasibility study at a Danish home health care institution with 27 home health care aides. The 6SQuID framework was used to develop, test and evaluate the feasibility of the organizational intervention, inspired by the 'Goldilocks Work Principle'. The intervention consisted of three activities: (1) classification workshop, (2) individual dialogue with a schedule coordinator, and (3) reorganizing work schedules. Feasibility was assessed through: (1) acceptability evaluated by interview and questionnaire post-intervention, (2) fidelity assessed by documentation during intervention, and (3) potential effects on selected psychosocial factors and physical work demands evaluated pre-post intervention with technical measurements and questionnaire.

RESULTS

Nineteen home health care aides participated in the evaluation of the intervention. Most of the home health care aides (73.33%) reported to like or really like the intervention. The interviewees expressed general acceptance of both the intervention activities and the overall aim of the intervention. Most home health care aides (77.8%) participated in the Classification workshop and 124 citizens were classified. All home health care aides participated in the Individual dialogue. No significant changes were seen in the Reorganized work schedules (p > 0.05). Physical and emotional fatigue and physical exertion showed statistically significant change (p < 0.05), with a mean difference of 17 and 11 (100 point scale), and 1.7 (10 point scale) points respectively.

CONCLUSION

This study found components of the intervention to be feasible, but concludes that adaptions to enhance implementation addressing barriers related to time pressure, improving fidelity to the intervention, and ensuring practical applicability within the home health care context are critical for future success.

TRIAL REGISTRATION

The study was registered in the ISRCTN registry under registration number ISRCTN15131198 on August 8, 2023.

Effectiveness of improving nutrition on depressive symptoms and work ability: Study protocol for the mind nutrition randomized controlled trial

Background: Depression is a growing public health concern that negatively impacts work ability and performance. Psychiatric nurses have an elevated risk for depressive symptoms, and it is essential to ensure their good mental health and work ability. The association between nutrition and depression is recognized, but there is a need for randomized, controlled intervention studies investigating the effectiveness of diet on depressive symptoms and related work impairment. Aim: Mind Nutrition is a randomized, controlled intervention study examining whether improving nutrition can reduce depressive symptoms and depressive symptoms-related sick leaves and enhance work ability and quality of life among mental health and substance abuse professionals. Methods: We will recruit 125 nurses and social welfare professionals from the mental health and substance abuse field of the Satakunta Wellbeing Services County. Half of the participants will be randomized to the intervention and half to the control group. Subjects in the intervention group will participate in two individual and three group counselling sessions during a 6-month intervention. Nutrition counselling follows the Finnish Nutrition Recommendations. The control group will maintain their habitual diet. The Center for Epidemiological Studies - Depression, depressive symptoms-related sick leave days, two work ability indicators, a Food Frequency Questionnaire, three-day food records, Three-Factor Eating Questionnaire - 18 and WHO-8 Eurohis Quality of Life will be assessed at baseline and 6 months. Summary: This study will provide evidence of the effectiveness of nutrition counselling on depressive symptoms and related sick leave days, work ability and quality of life.

Effects of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Four-Armed Randomized Controlled Trial

BACKGROUND

Anxiety disorders are the most common mental health conditions worldwide, yet 65% of those affected do not access services. The high prevalence of anxiety and the low rate of intervention uptake highlight the urgent need to develop timely, scalable, and effective interventions suitable for adolescents. This study adapted existing single-session interventions (SSIs) to further develop an SSI focused on a growth mindset regarding negative emotions for adolescent mental health.

OBJECTIVE

The study aims to compare the effectiveness of 4 SSIs, SSI of a growth mindset for anxiety (SIGMA), SIGMA with boosters (SIGMA-Booster), SSI of a growth mindset of personality (SSIGP), and an active control group (support therapy [ST]), in reducing adolescent anxiety.

METHODS

Classes from each secondary school were randomized to 1 of 4 intervention conditions: SIGMA, SIGMA-Booster, SSIGP, or ST. Each intervention took approximately 45 minutes online. Participants reported on anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-harming thoughts, perceived control, hopelessness, attitude toward help-seeking, and psychological well-being (secondary outcomes) at preintervention, 2-week follow-up, and 8-week follow-up. Participants also completed a feedback scale postintervention. Generalized estimating equations were used to examine the effectiveness of the SSIs.

RESULTS

A total of 731 adolescents from 7 secondary schools were randomized. The intent-to-treat analysis found a significant decrease in anxiety symptoms. The mean and 95% CI at baseline were 6.8 (6.0-7.6) for SIGMA-Booster, 6.5 (5.8-7.3) for SIGMA, 7.0 (6.2-7.7) for SSIGP, and 6.9 (6.1-7.7) for ST. At the 2-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.7 (4.9-6.5) for SIGMA, 5.4 (4.6-6.2) for SSIGP, and 5.7 (4.9-6.4) for ST. At the 8-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.3 (4.5-6.0) for SIGMA, 5.6 (4.8-6.4) for SSIGP, and 5.8 (5.1-6.6) for ST. These reductions were observed across all 4 groups. Moderation analysis found that participants with higher motivation for change, higher baseline anxiety scores, and fixed mindsets showed greater improvements in anxiety symptoms. Most participants (459/731, 62.8%) viewed the feasibility and acceptability of the SSIs positively.

CONCLUSIONS

The SSI for all 4 groups was effective in reducing anxiety and depression among adolescents over 8 weeks. Our data suggest the potential benefits of brief web-based interventions for adolescents, which could serve as scalable, destigmatized, and cost-effective alternatives to school-based programs. The intervention effects may have been underestimated, as this study did not exclude adolescents with minimal or no anxiety symptoms. Future studies should focus on the specific effects of interventions for adolescents with varying levels of anxiety symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880.

Evaluation of a Curriculum-Based Nutrition Education Intervention Protocol in Elementary Schools: Nonrandomized Feasibility Study

Background

Improving children's food literacy through school-based interventions can support developing healthy eating habits. However, teachers lack appropriate resources, time, and training to provide nutrition education in schools. Serious games, which are games designed for a purpose other than entertainment, have been demonstrated to improve children's food literacy and dietary intake and can address the barriers teachers face in providing nutrition education. Foodbot Factory (Arcand Lab) is a nutrition education intervention that is aligned with curricula and uses a serious game to provide nutrition education to students. Further evidence is needed to understand how serious games, including Foodbot Factory, can be researched in schools to support nutrition education.

Objective

The objective of this study was to evaluate the feasibility of a research study protocol that implements the curriculum-based nutrition education intervention Foodbot Factory into a real-world classroom setting. The evaluation of the protocol included study processes, resources, and management feasibility outcomes, as well as a preliminary assessment of scientific outcomes relevant to the intervention.

Methods

A nonrandomized study determined the feasibility of intervention implementation. Grade 4 and 4/5 classrooms were assigned to have nutrition education lessons for 5 days with either the Foodbot Factory or a control intervention. Outcomes were assessed in 4 feasibility domains of study processes (eg, recruitment and attrition rates), resources (eg, time taken to deliver the intervention), and management (eg, challenges with intervention delivery), and a preliminary assessment of scientific outcomes pertaining to the acceptability and impacts of the interventions. These outcomes were captured in semistructured field notes completed by study staff and a Nutrition Attitudes and Knowledge questionnaire and acceptability questionnaire completed by participants. Data were analyzed descriptively and using a paired t test to assess within-group changes in nutrition knowledge.

Results

In total, 4 classrooms participated in the feasibility study, with varying recruitment rates for schools (3/20, 15%), classrooms (4/4, 100%), parents (54/102, 53%), and children (49/54, 91%). The time required to implement the research protocol, including data collection and lesson plans, was sufficient and management of the intervention implementation was overall successful. Some challenges were experienced with classroom management during data collection, specifically with electronic data collection. After the intervention, participants reported a positive affective experience (26/41, 63%) and learning something new about healthy eating (31/41, 76%). Participants in both study groups improved their nutrition knowledge, but the changes were not statistically significant. The Foodbot Factory group had a statistically significant improvement in their knowledge of vegetables and fruit (P=.04) and protein foods (P=.03).

Conclusions

These findings indicate that the study protocol is feasible to implement and evaluate Foodbot Factory in a representative sample with select modifications to improve recruitment and data collection procedures.

Acceptability, Usability, and Insights Into Cybersickness Levels of a Novel Virtual Reality Environment for the Evaluation of Depressive Symptoms: Exploratory Observational Study

BACKGROUND

There is a clear need for enhanced mental health assessment, depressive symptom (DS) evaluation being no exception. A promising approach to this aim is using virtual reality (VR), which entails the potential of adding a wider set of assessment domains with enhanced ecological validity. However, whilst several studies have used VR for both diagnostic and treatment purposes, its acceptance, in particular how exposure to virtual environments affects populations with psychiatric conditions remains unknown.

OBJECTIVE

This study aims to report on the acceptability, usability, and cybersickness levels of a pilot VR environment designed for the purpose of differentiating between individuals with DSs.

METHODS

The exploratory study, conducted in Italy, included 50 healthy controls and 50 young adults with mild-to-moderate DSs (without the need for a formal diagnosis). The study used an observational design with approximately 30 minutes of VR exposure followed by a self-report questionnaire battery. The battery included a questionnaire based on the Theoretical Framework of Acceptability, the System Usability Scale as well as the Simulator Sickness Questionnaire.

RESULTS

Results indicate that the majority found VR acceptable for the purposes of mental health screening and treatment. However, for diagnostics, there was a clear preference for VR to be used by mental health professionals as a supplementary tool, as opposed to a stand-alone solution. In practice, following exposure to the pilot VR environment, generally, good levels of acceptability and usability were reported, but areas in need of improvement were identified (such as self-efficacy). Self-reported cybersickness levels were comparable to literature averages but were considerably higher among those with DSs.

CONCLUSIONS

These findings raise questions about the potential interplay between underlying somatic symptoms of depression and VR-induced cybersickness and call for more attention from the scientific community both in terms of methodology as well as potential clinical and theoretical implications. Conclusively, user support indicates a potential for VR to aid mental health assessment, but further research is needed to understand how exposure to virtual environments might affect populations with varying severity and other forms of psychiatric symptoms.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/ISRCTN16396369.

Acceptability of Vaginal Human Papillomavirus Self-Collection Among Colposcopy Clinic Attendees

Background

Cervical cancer screening with a self-collected vaginal specimen for human papillomavirus (HPV) testing was approved by the U.S. Food and Drug Administration in May 2024, offering a potential solution to declining screening rates.

Objective

We aimed to assess acceptability of clinic-based vaginal specimen self-collection for HPV testing and to evaluate associations between participants' sociodemographics and their likelihood of choosing self-collection for future screening and the overall acceptability of using the Evalyn® brush device. We also evaluated associations between specific acceptability constructs and reported likelihood to use the device in the future and overall acceptability.

Methods

Following self-collection of a vaginal specimen, participants completed an electronic survey that measured constructs from the Theoretical Framework of Acceptability. Associations were assessed using logistic regressions. The study was conducted at a colposcopy clinic in the Gynecology department of a midwestern academic medical center in the United States from November 2022 through July 2023.

Results

Participants (n = 81) reported high likelihood (98% likely or very likely) of choosing in-home self-collection for future screening and unanimity on overall acceptability (100% acceptable or completely acceptable) of using the device. More affirmative responses to measures on instruction understandability, ease of device use, understanding the device is used for cervical cancer screening, and perceiving self-collection improves screening rates were associated with a higher likelihood to choose self-collection for future screenings and overall acceptability of the device (all p values <0.05).

Conclusion

Vaginal specimen self-collection for HPV testing was well-received in the studied population, with high acceptability and likelihood of uptake. Implementation efforts should provide user-friendly instructions and emphasize the benefits of self-collection for cervical cancer screening, particularly among people less likely to engage with clinician-collected speculum-based screening.

The Acceptability of Occupational Therapy Using Zones of Regulation™ Concepts in an Equine Environment to Autistic Children

Autistic children often have impaired self-regulation which can impact daily functioning and life outcomes. Occupational Therapy Using Zones of Regulation™ Concepts in an Equine Environment (OT-ZOR-Equine) is a standardized intervention that integrates both the Zones of Regulation™ curriculum and horses into occupational therapy to address self-regulation in autistic children. We aimed to assess the acceptability of OT-ZOR-Equine to participating autistic children. A qualitative descriptive research study was conducted with six autistic children ages 7-9 years who received ten weeks of OT-ZOR-Equine. Children participated in semi-structured interviews that used questions guided by the Theoretical Framework of Acceptability. We analyzed interview transcripts using directed content analysis. Autistic children found OT-ZOR-Equine to be generally acceptable. The children especially enjoyed horse riding but found the Zones of Regulation™ curriculum and certain aspects of riding to be less acceptable. Tailoring OT-ZOR-Equine to integrate each client's preferences and needs may make this intervention more acceptable to autistic children. The findings of this study support the continued use of and research on OT-ZOR-Equine or similar occupational therapy interventions that integrate horses to influence self-regulation in autistic children.

Evaluation of risk stratification and problem management plus (PM+) for pregnant women with HIV in Kenya (Tatua study): Protocol paper

BACKGROUND

While many pregnant and postpartum women with HIV (PPWH) in the African Region successfully engage in HIV care, a substantial number still face significant barriers, including poor mental health and HIV stigma. These psychosocial barriers contribute to poor medication and clinic visit adherence, poor health outcomes, including unsuppressed viral load, and increased risk of perinatal transmission of HIV. To efficiently improve health outcomes within a resource-constrained health system, responsive and effective interventions are urgently needed to support women who are at the highest risk of sub-optimal outcomes.

OBJECTIVE

To determine whether risk stratification of PPWH in conjunction with an evidence-based, tailored, lay health worker-delivered psychological intervention can optimize health outcomes for PPWH and their infants.

METHODS

Using human-centered design, we will adapt Problem Management Plus (PM+) with PPWH for in-person and mobile delivery formats to prevent sub-optimal treatment adherence and HIV care disengagement among PPWH in Kisumu, Kenya. We will test the adapted PM+ intervention among 120 PPWH randomized 1:1:1 to standard of care, in-person PM+, or mobile PM+ in a hybrid type 2 implementation effectiveness pilot trial. Implementation outcomes, including feasibility, acceptability, and intervention satisfaction, as well as preliminary effectiveness outcomes in mental health and HIV, will be evaluated.

EXPECTED STUDY OUTCOMES

We anticipate that the adapted PM+ intervention will be highly acceptable and feasible to implement and have the potential to be effective at reducing care disengagement, viremia, and psychological distress in PPWH.

Student-Led Mobility Interventions for Hospitalized Adults: A Mixed-Methods Feasibility and Acceptability Study

BACKGROUND

Inactivity in hospitalized patients often leads to functional decline. We created an undergraduate course to promote mobilization, provide hands-on learning, and address staff shortages.

PURPOSE

To assess the feasibility and acceptability of undergraduate students providing mobility-focused interventions for hospitalized adults.

METHODS

This mixed-methods study was conducted at a level 1 trauma academic center. We analyzed program feasibility and acceptability using quantitative data and thematic analysis of interviews and focus groups.

RESULTS

In total 47 individuals (n = 14 students, n = 9 patients, and n = 24 clinicians) were included. Students averaged 4.1 mobility sessions per 4-hour shift. All stakeholders agreed the program is acceptable, and 98.6% affirmed the program is feasible. The themes identified included positive impacts on patient care, enhanced student professional development, and practical implementation challenges.

CONCLUSIONS

Student-led mobility interventions can be an acceptable strategy to mitigate immobility harm in hospitalized patients. The integration of students enhances patient care and provides valuable educational experiences.

Implementation of Transdiagnostic Psychosocial Group Interventions and a Novel Peer Work Role in a Community Youth Mental Health Setting

AIMS

Group interventions can be an appropriate care option for young people with mental ill-health, yet there is a lack of research on their implementation within real-world settings. This paper aimed to explore the feasibility and acceptability of group interventions and a Group Coordinator peer work role in a community mental health service and the perspectives of young people, carers and staff on implementation.

METHODS

A retrospective chart audit of 121 referrals to group interventions from January 2022 to June 2023 was conducted. Education, demographic and administrative data were collected to explore feasibility and acceptability. Survey data from 44 young people who participated was also used to explore acceptability. Semi-structured interviews (8 young people, 7 carers and 11 staff) explored perspectives on implementation, mapping barriers and facilitators to domains of the Comprehensive Framework for Implementation Research.

RESULTS

Referrals made before the young person was involved in mental health treatment (i.e., at the stage of assessment) were less likely to result in engagement in a group, suggesting limited feasibility as a standalone care option. Young people reported overall positive experiences of group interventions, though attrition rates and qualitative interviews indicate they are perceived as less acceptable than individual options. The Group Coordinator role was viewed by staff as key to sustainability, with multiple benefits.

CONCLUSIONS

The current paper contributes to the scant literature on the implementation of group interventions with several practical implications for service planning. Further studies are needed to examine the implementation in other contexts, explore within-treatment variables and incorporate clinical outcomes.

Measuring sustainability in social enterprises: Development and validation of a multi-dimensional framework

Social enterprises (SEs) are instrumental in achieving the Sustainable Development Goals (SDGs) by addressing persistent social, environmental, and economic challenges. However, the lack of validated frameworks to measure SE sustainability limits their ability to measure and strengthen their sustainable performance, which further hinders the capacity to drive transformative change as intended by the SDGs. Hence, this study aims to develop and validate a multidimensional scale for measuring the sustainability performance of SEs, enabling them to realise their potential and enhance their contributions to the SDGs. This study utilized (Churchill, 1979) three-phase methodology to develop and validate sustainability performance measurement scale for SEs. Phase 1 identified sustainability-related items through a literature review and qualitative analysis, finalized by an expert panel. Phase 2 refined these items using exploratory factor analysis (EFA) on 149 SEs (sample 1) data. Phase 3 validated the structure with confirmatory factor analysis (CFA) on data from 435 SEs (sample 2). The final scale included 36 items across five dimensions: social, economic, environmental, political, and governance, subject to the validity and reliability of the newly developed scale. Reliability was confirmed, with Cronbach's alpha exceeding 0.7 for all dimensions. Convergent validity was supported by AVE scores above 50 %, while HTMT ratios below 0.85 established discriminant validity. This research significantly contributes to the literature on SE sustainability by providing a validated performance measurement tool, which enables SEs to optimize their operations, strengthen their impact, and contribute more effectively to the SDGs.

Behavioural interventions to increase uptake of FIT colorectal screening in Scotland (TEMPO): a nationwide, eight-arm, factorial, randomised controlled trial

BACKGROUND

Uptake of colorectal cancer screening is suboptimal. The TEMPO trial evaluated the impact of two evidence-based, theory-informed, and co-designed behavioural interventions on uptake of faecal immunochemical test (FIT) colorectal screening.

METHODS

TEMPO was a 2 × 4 factorial, eight-arm, randomised controlled trial embedded in the nationwide Scottish Bowel Screening Programme. All 40 000 consecutive adults (aged 50-74 years) eligible for colorectal screening were allocated to one of eight groups using block randomisation: (1) standard invitation; (2) 1-week suggested FIT return deadline; (3) 2-week deadline; (4) 4-week deadline; (5) problem-solving planning tool (no deadline); (6) planning tool plus 1-week deadline; (7) planning tool plus 2-week deadline; (8) planning tool plus 4-week deadline. The primary outcome was the proportion of FITs returned correctly completed to be tested by the colorectal screening laboratory providing a positive or negative result, within 3 months of the FIT being mailed to a person. The trial is registered with clinicaltrials.gov, NCT05408169.

FINDINGS

From June 19 to July 3, 2022, 5000 participants were randomly assigned per group, with no loss to follow-up. 266 participants met the exclusion criteria; 39 734 (19 909 [50·1%] female and 19 825 [49·9%] male; mean age 61·2 [SD 7·3] years) were included in the analysis. The control group (no deadline, and no planning tool) had a 3-month FIT return rate of 66·0% (3275 of 4965). The highest return rate was seen with a 2-week deadline without the planning tool (3376 [68·0%] of 4964; difference vs control of 2·0% [95% CI 0·2 to 3·9]). The lowest return rate was seen when the planning tool was given without a deadline (3134 [63·2%] of 4958; difference vs control of -2·8% [-4·7 to -0·8]). The primary analysis, assuming independent effects of the two interventions, suggested a clear positive effect of giving a deadline (adjusted odds ratio [aOR] 1·13 [1·08 to 1·19]; p<0·0001), and no effect for use of a planning tool (aOR 0·98 [0·94 to 1·02]; p=0·34), though this was complicated by an interaction between the two interventions (pinteraction=0·0041); among those who were given a deadline, there was no evidence that receiving a planning tool had any effect (aOR 1·02 [0·97 to 1·07]; p=0·53), but in the absence of a deadline, giving the planning tool appeared detrimental (aOR 0·88 [0·81 to 0·96]; p=0·0030). In the absence of the planning tool, there was little evidence that the use of a deadline had any effect on return rates at 3 months. However, secondary analyses indicated that the use of deadlines boosted earlier return rates (within 1, 2, and 4 weeks, particularly around the time of the deadline), and reduced the need to issue a reminder letter after 6 weeks, with no evidence that the planning tool had any positive impact, and without evidence of interactions between interventions.

INTERPRETATION

Adding a single sentence suggesting a deadline for FIT return in the invitation letter to FIT colorectal screening resulted in more timely FIT return and reduced the need to issue reminder letters. This is a highly cost-effective intervention that could be easily implemented in routine practice. A planning tool had no positive effect on FIT return.

FUNDING

Scottish Government and Cancer Research UK.

Gait Rehabilitation for Early rheumatoid Arthritis Trial (GREAT): lessons learnt from a mixed-methods feasibility study and internal pilot trial

Background

People with rheumatoid arthritis experience foot and lower limb pain due to active synovitis, resulting in impaired lower limb function. Earlier intervention may help with prevention of functional decline. The aims of this research were to develop and evaluate a new gait rehabilitation intervention for people with early rheumatoid arthritis, evaluate its feasibility, and to test whether or not gait rehabilitation plus usual care is more clinically and cost-effective than usual care alone.

Design and methods

We undertook a single-arm, repeated-measures, pre- and post-intervention, mixed-methods feasibility study with embedded qualitative components. We planned to undertake a pragmatic, two-arm, multicentre, superiority randomised controlled trial, with health economic evaluation, process evaluation and internal pilot.

Setting and participants

Participants with early rheumatoid arthritis (< 2 years post diagnosis) were identified from early arthritis and rheumatology outpatient clinics and referred for intervention in either podiatry or physiotherapy clinics.

Intervention(s)

Participants were randomised to a gait rehabilitation programme (Gait Rehabilitation Early Arthritis Trial Strides) involving a six-task gait circuit. Sessions were underpinned by motivational interviewing to facilitate behaviour change, supported by trained physiotherapists or podiatrists for a minimum of two sessions. Both groups received their normal usual care from the rheumatology multidisciplinary team.

Main outcome measures

Outcome measures for the feasibility study were intervention acceptability, adherence using the Exercise Adherence Rating Scale and fidelity using the Motivational Interviewing Treatment Integrity Scale. The main outcome measure for the internal pilot/randomised controlled trial was the Foot Function Index disability subscale. Outcomes were measured at baseline, 3 months, 6 months and 12 months. Other outcomes: intervention acceptability questionnaire, Exercise Adherence Rating Scale, exercise treatment beliefs via the Theory of Planned Behaviour Questionnaire, intervention fidelity (Motivational Interviewing Treatment Integrity Scale), health-related quality of life (EuroQol-5 Dimensions, five-level score).

Results

Thirty-five participants were recruited for feasibility and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent: 21/23 were confident that it could help and would recommend it and 22/23 indicated it made sense to them. Adherence was good, with a median (interquartile range) Exercise Adherence Rating Scale score of 17/24 (12.5-22.5). Twelve participants' and nine therapists' interviews confirmed intervention acceptability, identified perceptions of benefit, but highlighted some barriers to completion. Motivational Interviewing Treatment Integrity Scale scores demonstrated good fidelity. The trial did not progress from internal pilot to full main trial as a result of low recruitment and high attrition, after 53 participants were recruited from 9 sites over 12 months. Process evaluation confirmed good intervention acceptability and adherence, and fair fidelity. Evaluation of clinical and cost-effectiveness was not possible.

Limitations

Significant delays were experienced with the impact of coronavirus disease 2019, regulatory approvals, contracts and site readiness, resulting in few sites opening in time and low recruitment capacity. Foot and/or ankle pain prevalence was lower than anticipated, resulting in a low potential participant pool and a low conversion rate from screening to enrolment.

Conclusions

The Gait Rehabilitation Early Arthritis Trial Strides intervention was acceptable to people with early rheumatoid arthritis and intervention clinicians, safe, with good levels of adherence by participants, and fair intervention fidelity. The randomised controlled trial stopped early following failure to meet recruitment targets. Gait Rehabilitation Early Arthritis Trial Strides is a promising intervention that could be adapted for future evaluations. A definitive trial of the Gait Rehabilitation Early Arthritis Trial Strides gait rehabilitation intervention still needs to be done.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/165/04.

The People's Review protocol: planning an innovative study powered by the public

BACKGROUND

Systematic reviews provide the best quality evidence about the effectiveness of health treatments. However, systematic reviews and the important role they play in healthcare are not well understood beyond the walls of academia and healthcare. Systematic reviews can help the public make more informed health choices, based on the best available evidence. The People's Review aims to provide an opportunity to members of the public to plan and complete a full systematic review online in a supportive and engaging manner. It will be a learning-by-doing experience to support the public's understanding of what reviews are, how they are done, why they matter, and how they can be used to support everyday health decisions.

METHODS

In The People's Review the public will conduct a full systematic review, deciding the review question, planning the review, working on the parts of the review, and deciding how to share the review findings, in a 'learning by doing' process. The review will be conducted online in eight stages using Cochrane Crowd, an existing citizen science platform. The team working behind-the-scenes of The People's Review will design, produce, and share learning material to support the public's understanding at each stage of the review.

DISCUSSION

Involving the public in a systematic review online will enable members of the public to understand and use systematic reviews in everyday health choices. It provides the public with a unique 'learning by doing' opportunity to get to grips with what systematic reviews are and how they are produced. This article describes how we plan to involve the public in The People's Review. It is not a protocol for the systematic review itself - this will be published separately once the project has commenced, and the public have decided the review question.

Measuring Patient-Reported Acceptability Outcomes via the Program Acceptability Tool for Telehealth

Introduction: Assessing treatment acceptability is critical to understanding patient experiences in clinical trials, especially in telehealth settings where exposure and engagement experiences are unique. However, the use of patient-reported acceptability outcomes in mental health-focused trials has been mixed, with most published studies relying on objective behavior (e.g., dropout rates) or fit-for-use measures, rather than instruments rooted in a specific theoretical model. This study introduces the Program Acceptability Tool for Telehealth (PATT), a novel, theoretically grounded instrument designed to capture patient-reported acceptability in telehealth-based trials. Methods: Here, we describe the initial development and validation of the PATT, including its performance with 123 caregivers participating in an ongoing clinical trial that includes multiple types of interventions and support programs focused on caregiver well-being. Results: The final 12-item PATT demonstrated robust psychometric properties, including high internal consistency (α = 0.82-0.90) and content validity. Convergent validity was established through significant correlations between PATT scores and behavioral engagement metrics. Conclusions: Our findings suggest that the PATT is a reliable, valid tool for capturing patient acceptability, offering a nuanced perspective on program, process, and impact-related experiences. Further validation studies are recommended to confirm the PATT's utility in broader applications.

Rehabilitation after bone marrow transplant compared with usual care to improve patient outcomes (REBOOT): protocol for a randomised controlled trial

BACKGROUND

Haematological cancer affects more than 1.3 million people around the world annually and accounted for almost 800,000 deaths globally in 2020. The number of patients with these cancers undergoing bone marrow transplant is increasing. Of note, this intensive treatment is associated with complex and multifactorial side effects, often impacting nutritional status, physical functioning and overall health-related quality of life. The primary aim of this study is to investigate the effectiveness of an eight-week multidisciplinary rehabilitation intervention compared with usual care on the physical function domain of the European Organisation for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30 version 3) in patients with haematological cancer following bone marrow transplant.

METHODS

This is a multisite, pragmatic two-arm parallel-group, randomised controlled trial (RCT) with stratified randomisation, powered for superiority, recruiting 170 participants at 30 days following either allogeneic or autologous bone marrow transplant (ACTRN12622001071718). Recruitment sites include three Australian university affiliated teaching hospitals. Participants are eligible if aged ≥ 18 years, treated for haematological cancer with allogeneic or autologous bone marrow transplant and can walk independently. The intervention group will receive eight weeks of twice weekly telehealth-based exercise classes, an initial and follow up dietetics consult, post exercise protein supplements, and a home-based physical activity program, all with embedded behaviour change strategies. The primary outcome is patient reported physical function measured using the EORTC QLQ-C30 version 3. Secondary outcomes include other domains of the EORTC QLQ-C30, fatigue, physical function, physical activity levels, frailty, body composition, sarcopenia and nutrition assessment. We will also undertake a health economic analysis alongside the trial and a process evaluation exploring intervention fidelity, causal mechanisms as well as contextual influences through qualitative enquiry.

DISCUSSION

The REBOOT trial will add RCT-evidence from a rigorously conducted, statistically powered multi-site trial to existing limited knowledge on the effects of multi-disciplinary rehabilitation for people with haematological cancer. If effectiveness is supported, then implementation of rehabilitation into care pathways for people having bone marrow transplant can be considered.

TRIAL REGISTRATION

ACTRN12622001071718 prospectively registered 03/08/2022, last updated 08/03/2024.

The acceptability, feasibility, and usability of a virtual reality pain education and rehabilitation program for Veterans: a mixed-methods study

Introduction

Persistent pain is a leading cause of medical discharges for Veterans. Pain science education (PSE) aims to better people's understanding about pain and is effective at reducing pain and depressive symptoms in Veterans. Preliminary evidence suggests virtual reality (VR)-delivered PSE has clinical benefits for people with persistent pain. This study investigated the acceptability, feasibility, and usability for VR-PSE for Veterans with persistent pain.

Methods

Veterans (n = 7) and healthcare professionals (HCPs) experienced in treating Veterans (n = 5) participated in workshops that involved working through the VR-PSE program, online questionnaires, and a focus group. Quantitative data were analysed by descriptive statistics. Qualitative data were analysed using a framework analysis according to the Theoretical Framework of Acceptability (TFA). A mixed-methods analysis combined the quantitative and qualitative data via triangulation, with the findings presented according to the TFA domains.

Results

The VR-PSE program was considered easy to use, engaging, and adaptable for different functional capabilities. Appropriate screening for contraindications prior to using the VR-PSE program was considered important by HCPs. Both Veterans and HCPs emphasized the need for a trusting client-clinician relationship to improve the acceptability of the VR-PSE program.

Discussion

Overall, the VR-PSE program was found to be acceptable, feasible, and usable and may be a useful tool to incorporate into the clinical management of Veterans with persistent pain. Further research is needed to investigate the efficacy of VR-PSE programs on clinical outcomes for Veterans with persistent pain.

Nucleus accumbens deep brain stimulation in adult patients suffering from severe and enduring anorexia nervosa (STIMARS): protocol for a pilot study

Background

Affecting adolescent and young adults, anorexia nervosa (AN) has the highest death rate of all mental disorders. Effective treatment options are lacking and a significant proportion of patients develop severe and chronic forms of the disease with long-lasting functional impairment. Neurobiology of AN implicates the nucleus accumbens as a core structure of the ventral striatum highly connected to the prefrontal cortex, the insula and the limbic system. Several studies reported promising results of deep brain stimulation for treatment-resistant AN. The aim of this study was to investigate the safety and efficacy of bilateral nucleus accumbens deep brain stimulation in severe and enduring AN.

Methods and analysis

This is a prospective, multicentre, single-arm, open-label, non-randomized pilot trial of bilateral nucleus accumbens deep brain stimulation for severe and enduring AN. Patients will be followed up for 24 months after deep brain stimulation. The main objective of this study is to measure the safety and feasibility of nucleus accumbens deep brain stimulation in this population. The recruitment rate will be collected prospectively. Potential deep brain stimulation efficacy will be monitored by changes in: 1) health-related quality of life; 2) weight; 3) eating disorder symptomatology; 4) neuropsychological changes of cognitive flexibility, habits formation, emotional processing and central coherence; 5) psychiatric comorbidities (anxiety, depression, obsession). Local field potential recordings during an exposure task will be proposed to the patients. Additionally, caregiver quality of life will be assessed.

Discussion

We present the design and rationale for a pilot study investigating the safety of nucleus accumbens deep brain stimulation for treatment resistant anorexia nervosa. This trial will provide an estimated effect size of nucleus accumbens deep brain stimulation for treatment-resistant anorexia nervosa to support future larger-scale clinical trials.

Protocol for an Exploratory RCT of the Traumatic Stress Relief Intervention With Persons With Lived Experience of Leprosy in Addis Ababa, Ethiopia

Objectives: Neglected tropical diseases (NTDs), such as leprosy, significantly impact mental health and overall well-being. This study aims to evaluate the effectiveness and acceptability of a mental health intervention targeting individuals affected by leprosy in Ethiopia. The intervention utilizes the Traumatic Stress Relief (TSR) program to target symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to improve overall mental health. Methods: This exploratory randomized controlled trial (RCT) will recruit participants with lived experiences of leprosy. Participants will receive four group sessions of a low-intensity TSR intervention. The intervention will be administered by a pair of trained facilitators, including one mental health practitioner and one community member with lived experience of leprosy. Data will be collected through self-report questionnaires to assess changes in PTSD symptoms, anxiety, and depression. In addition, interviews will provide further insights into participants' experiences and the acceptability of the intervention. Discussion: This exploratory trial will provide insights into the feasibility of mental health interventions for individuals affected by leprosy. The findings will inform the design of future trials to evaluate the effectiveness of such programs on a larger scale and in more diverse contexts. Trial Registration: The UK's Clinical Study Registry: ISRCTN868254411.

Protocol for a randomised controlled feasibility trial of an integrated psychosexual intervention for sexual difficulties in people with Multiple Sclerosis: the PIMS trial

BACKGROUND

Multiple Sclerosis (MS) is a long-term condition that significantly diminishes quality of life (QoL). Sexual difficulties (SDs) are common, but often overlooked symptom, affecting 50-80% of people with MS (PwMS). The emergence of SDs in MS results from the intricate interplay of disease processes, treatments, and psychosocial factors, contributing to a further decline in QoL and adverse effects on body image, relationships, and psychological well-being. Despite the limited treatment options, which mainly include medications and physiotherapy, there is promise in psychological interventions for addressing SDs in PwMS, although integrating them into routine care poses challenges. This protocol details the trial assessing the acceptability and feasibility of an eight-session, clinicians supported integrated Psychosexual Intervention for people with Multiple Sclerosis (PIMS).

METHODS

This is a multicentre interventional two-arm randomized feasibility trial with a nested qualitative study to gather preliminary data about the intervention and the feasibility of conducting a full-scale trial. We aim to recruit 50 PwMS across three research sites in England's National Health Service (NHS). Participants will be randomised to either the PIMS intervention (comprised of 8 sessions: 6 self-led and 2-facilitator led over the course of 12 weeks) or psychosexual education (one appointment with a facilitator to discuss treatment options). Feasibility will be assessed by collecting descriptive data on recruitment and retention rates and willingness to be randomised according to Consolidated Standards of Reporting Trials (CONSORT) feasibility and pilot trial guidelines. Patient reported outcomes (e.g., measures of sexual functioning and distress, psychological functioning, and quality of life) will be measured at baseline and follow up 14-weeks after randomisation. We will also use a nested qualitative study will use inductive thematic analysis to identify barriers to engagement with and delivery of the intervention, and to make appropriate modifications to PIMS.

DISCUSSION

The PIMS intervention will be the first integrated psychosexual intervention developed for people with Multiple Sclerosis in the UK. Assessing the feasibility of PIMS is an important first step to establishing future implementation and efficacy via a definitive randomised controlled trial.

TRIAL REGISTRATION

This trial is registered at ISRCTN: 12202900 . Registration date: 28th February 2023; Retrospectively registered. IRAS identification: 305830. NIHR award reference: NIHR202006. Trial sponsorship: This trial is co-sponsored by South London and Maudsley NHS Foundation Trust and King's College London.

CONTACT

 slam-ioppn.research@kcl.ac.uk.

PROTOCOL VERSION

 2.0, 10th February, 2025.

Navigating the risks: Stakeholder views on risk-based cervical cancer screening

BACKGROUND

The development of risk-based cancer screening programs requires a paradigm shift in existing practices and healthcare policies. Therefore, it is crucial to not only assess the effectiveness of new technologies and risk prediction models but also to analyze the acceptability of such programs among healthcare stakeholders. This study aims to assess the acceptability of risk-based cervical cancer screening (RB CCS) in Estonia from the perspectives of relevant stakeholders.

METHODS AND MATERIALS

This qualitative study employed semi-structured interviews with healthcare policy and service level stakeholders in Estonia. The Theoretical Framework of Acceptability guided the interview design, and the findings were charted using framework analysis based on the Consolidated Framework for Implementation Research.

RESULTS

17 interviews were conducted with stakeholders, including healthcare professionals, cancer registry representatives, technology specialists, policymakers, and health insurance providers. While stakeholders generally supported the concept and potential benefits of RB CCS, recognizing its capacity to improve screening outcomes and resource allocation, they raised significant concerns about feasibility, complexity, and ethical challenges. Doubts were expressed about the readiness of the healthcare system and population, particularly the current health information system's capacity to support risk-based approaches. The need for evidence-based and internationally validated screening models, comprehensive public communication, provider training, and collaborative discussions involving all relevant parties, including the public, was emphasized.

CONCLUSION

The favorable attitude towards RB CCS among stakeholders provides a strong foundation for advancing its development. However, a comprehensive strategy emphasizing the generation of robust evidence, strengthening healthcare infrastructure, prioritizing patient empowerment, and cultivating a collaborative environment built on trust is crucial.

Transcutaneous and transcranial electrical stimulation for enhancing military performance: an update and systematic review

Introduction

Electrical stimulation (ES), including transcranial electrical stimulation (tES) and transcutaneous vagus nerve stimulation (tVNS), has shown potential for cognitive enhancement in military contexts. Various types of ES, such as transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), modulate neuronal membrane potentials and cortical excitability, potentially improving cognitive functions relevant to military training and operations.

Methods

This systematic review updates previous findings by examining studies published between 2019 and 2024 that investigated electrical stimulation effects on cognitive performance in military personnel and tasks. We focused on whether the studies addressed key questions about the generalizability of lab findings to military tasks, the frequency and intensity of adverse effects, the impact of repeated ES administration, and the ethical and regulatory considerations for its use in potentially vulnerable military populations.

Results

Eleven studies met the inclusion criteria; most demonstrated overall low to some concerns, however, two of these had overall high risk of bias. While tES and tVNS showed some promise for enhancing multitasking and visual search performance, the results were mixed, with no reliable effects on vigilance tasks.

Discussion

The reviewed studies highlight the need for a better understanding of ES mechanisms, optimal stimulation parameters, and individual differences in response to ES. They also highlight the importance of conducting high-powered research in military settings to evaluate the efficacy, safety, and ethical implications of ES. Future research should address the generalizability of lab-based results to real-world military tasks, monitor the frequency and intensity of adverse effects, and explore the long-term impacts of repeated administration. Furthermore, ethical and regulatory considerations are crucial for the responsible application of ES in military contexts, and a series of outstanding questions is posed to guide continuing research in this domain.

Perspectives of aged care home staff and health care professionals on the Psychotropic medicines use in Residents And Culture: Influencing clinical Excellence (PRACTICE) tool ©

INTRODUCTION

High use of psychotropic medications continues to be common in residential aged care homes despite the risk of harm and limited efficacy in people living with dementia. Research has shown that the organizational culture of aged care homes influences psychotropic medication use in residents with dementia. The Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE) tool was developed to evaluate the organizational culture of aged care homes specific to the use of psychotropic medications.

OBJECTIVES

To evaluate the comprehensibility, relevance, and comprehensiveness of the PRACTICE tool among end-users.

METHOD

Cognitive interviews were conducted with participants representing a broad range of health disciplines across Australia. Interviews were performed using a combination of the think-aloud technique and verbal probing. Interviews were transcribed and content coded for participants' perceptions of the PRACTICE tool. Items were modified based on findings from the cognitive interviews, participants' suggestions for rewording of items and discussions with the research team.

RESULTS

A total of 20 cognitive interviews were conducted. Based on the cognitive interviews, 48 out of 63 items were modified. Reasons for modification were categorized into three themes: 1) Items changed to align with the aged care home staff's scope of practice; 2) Items adjusted to prevent unintended blame from reading the items; and 3) Items modified to prevent potential misinterpretation of their intended meaning. Three items were added to improve the comprehensiveness of the tool. Most participants reported that they understood the items and considered them as relevant and acceptable for the evaluation of organizational culture and use of psychotropic medication in aged care homes.

CONCLUSION

This study confirms that the PRACTICE tool is a comprehensive tool appropriate for the assessment of organizational culture specific to psychotropic medication use and is important for aged care home settings.

Patient Engagement in the Implementation of Electronic Patient-Reported Outcome Tools: The Experience of Two Early-Adopter Institutions in the Pan-Canadian Radiotherapy Patient-Reported Outcome Initiative

AIMS

To share the patient and community engagement experience of two Canadian early adopter sites that implemented electronic patient-reported outcomes collection in radiotherapy practice.

MATERIALS AND METHODS

In the first institution, the McGill University Health Centre, a socio-technical stakeholder co-design approach was used to develop a patient portal application (Opal) with built-in ePRO collection capability. Patient and family members were engaged through patient co-leadership, focus groups, semi-structured interviews, a persistent feedback form in the resultant application, and user satisfaction surveys. In the second institution, the Nova Scotia Health (NSH) centres of Dalhousie University's Department of Radiation Oncology, an industry-provided patient engagement tool was deployed. Patient and community engagement in the deployment effort was purposive to promote digital inclusion and diverse representation. Engagement was operationalized via a community feedback session and involvement of patient representatives in oversight committees.

RESULTS

The McGill experience highlighted 3 particular points of concern for patients when collecting ePROs: (1) Data flow should be two-way such that patients have access to their data from the hospital (lab results, clinical notes) as well as providing their data to the hospital (ePROs); (2) If ePROs are collected, they should be used actively by clinicians or the incentive for patients to continue reporting will be diminished; (3) The inherent rigour of electronic data collection may risk frustrating patients due to the inability to skip questions or spoil responses. The Dalhousie/NSH experience demonstrated the value and importance of including a diverse set of community representatives in building an ePRO program so that it can proactively account for real-world complexities and the challenge of simultaneously addressing the needs of diverse communities.

CONCLUSION

Two early-adopter Canadian cancer care programs reported on their experience and lessons learned with patient and community engagement in the rollout of their ePRO collection initiatives.

The acceptability, feasibility and adoption of a co-designed electronic post-injury psychosocial screening tool for carers of children admitted to hospital following injury

PURPOSE

This study aimed to evaluate the feasibility, acceptability and adoption of a co-designed electronic post-injury psychosocial screening tool for carers of paediatric trauma patients.

DESIGN AND METHODS

A mixed methods approach with a parallel convergent design was used. The study occurred at a tertiary paediatric hospital in Australia, with data collected between April 2023 and February 2024. Data were collected through electronic surveys, semi-structured interviews, and the psychosocial screening tool. Participants included caregivers of hospitalised children and clinicians from the hospital's trauma service.

RESULTS

Although both caregivers and clinicians found the tool feasible and acceptable, adoption rates were lower than expected. Key barriers included the tool's timing, which conflicted with caregivers' focus on physical recovery and emotional challenges discussing trauma. Clinicians viewed the tool as research-focused, limiting engagement. Logistical barriers, such as lack of clinician support and timing, further reduced adoption.

CONCLUSION

The tool showed potential for improving psychosocial support post-injury, but adoption was hindered by timing, emotional challenges and clinician engagement.

PRACTICE IMPLICATIONS

Clinicians must prioritise the acceptability, feasibility and adoption of tools when implementing caregiver support interventions for children with traumatic injuries. Future research should focus on overcoming implementation barriers and optimising psychosocial screening tools. Subsequent versions should align with caregivers' recovery timelines, embrace trauma-informed principles, promote clinician buy-in and be culturally tailored. Enhanced integration into clinical workflows and greater clinician engagement will boost adoption and effectiveness.

The Acceptability of a Tobacco Dependency Treatment for NHS Staff in the North East of England: A Mixed-Methods Study

AIMS

High smoking rates and deprivation levels in the North East of England have led to an opportunity to pilot a tobacco dependency treatment offer for NHS (National Health Service) staff who smoke, to make a supported quit attempt. The direct and indirect benefits to staff, patients, and NHS organisations are well documented. This study aimed to evaluate service acceptability.

METHODS

The service included up to 12 weeks of free nicotine replacement therapy (NRT) and/or a refillable e-cigarette, motivational support, and premium access to the Smoke-Free app. The service evaluation used a mixed-methods design, combining the Theoretical Framework of Acceptability (TFA) questionnaire and semi-structured interviews with staff who had accessed the offer. The quantitative data were analysed using descriptive statistics and qualitative data via thematic analysis.

RESULTS

Sixty-eight survey responses reflected high acceptability and revealed four themes relating to the service familiarity and ease of access, suitability of the NRT/E-liquid ordering service, the vape kit, and behavioural support.

CONCLUSIONS

The service was deemed highly acceptable, and service users' experiences informed recommendations for improving future tobacco dependency services. This is the first known application of the TFA to an evaluation of a smoking cessation intervention, and it contributes to a broader body of research on reducing tobacco dependency.

High-Intensity Interval Training for Individuals With Isolated Impaired Fasting Glucose: Protocol for a Proof-of-Concept Randomized Controlled Trial

BACKGROUND

Standard lifestyle interventions have shown limited efficacy in preventing type 2 diabetes among individuals with isolated impaired fasting glucose (i-IFG). Hence, tailored intervention approaches are necessary for this high-risk group.

OBJECTIVE

This study aims to (1) assess the feasibility of conducting a high-intensity interval training (HIIT) study and the intervention acceptability among individuals with i-IFG, and (2) investigate the preliminary efficacy of HIIT in reducing fasting plasma glucose levels and addressing the underlying pathophysiology of i-IFG.

METHODS

This study is a 1:1 proof-of-concept randomized controlled trial involving 34 physically inactive individuals (aged 35-65 years) who are overweight or obese and have i-IFG. Individuals will undergo a 3-step screening procedure to determine their eligibility: step 1 involves obtaining clinical information from electronic health records, step 2 consists of completing questionnaires, and step 3 includes blood tests. All participants will be fitted with continuous glucose monitoring devices for approximately 80 days, including 10 days prior to the intervention, the 8-week intervention period, and 10 days following the intervention. Intervention participants will engage in supervised HIIT sessions using stationary "spin" cycle ergometers in groups of 5 or fewer. The intervention will take place 3 times a week for 8 weeks at the Aerobic Exercise Laboratory in the Rehabilitation Hospital at Emory University. Control participants will be instructed to refrain from engaging in intense physical activities during the study period. All participants will receive instructions to maintain a eucaloric diet throughout the study. Baseline and 8-week assessments will include measurements of weight, blood pressure, body composition, waist and hip circumferences, as well as levels of fasting plasma glucose, 2-hour plasma glucose, and fasting insulin. Primary outcomes include feasibility parameters, intervention acceptability, and participants' experiences, perceptions, and satisfaction with the HIIT intervention, as well as facilitators and barriers to participation. Secondary outcomes comprise between-group differences in changes in clinical measures and continuous glucose monitoring metrics from baseline to 8 weeks. Quantitative data analysis will include descriptive statistics, correlation, and regression analyses. Qualitative data will be analyzed using framework-driven and thematic analyses.

RESULTS

Recruitment for the study is scheduled to begin in February 2025, with follow-up expected to be completed by the end of September 2025. We plan to publish the study findings by the end of 2025.

CONCLUSIONS

The study findings are expected to guide the design and execution of an adequately powered randomized controlled trial for evaluating HIIT efficacy in preventing type 2 diabetes among individuals with i-IFG.

TRIAL REGISTRATION

Clinicaltrials.gov NCT06143345; https://clinicaltrials.gov/study/NCT06143345.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/59842.

Rapid Verbal Persuasion to increase influenza vaccine uptake: protocol for a randomized hybrid type 2 effectiveness -implementation trial

BACKGROUND

While influenza vaccines are the most effective measure for preventing influenza, uptake rates in China remain relatively low. Rapid Verbal Persuasion (RVP), with highly rapid fashion, has a strong evidence base in promoting behavior change. Despite this, it is underused or rarely evaluated in the context of vaccination. Additionally, the success of RVP implementation in vaccination clinics hinges on the motivation of vaccination staff, which remains critical even with stable contextual factors. Multifaceted incentive-based implementation strategies, which aim to enhance motivation to promote the implementation of evidence-based practices, could be advantageous. This study protocol outlines an implementation-effectiveness hybrid type 2 design to evaluate the effectiveness of both the incentive-based implementation strategies on implementation outcomes and RVP on increasing influenza vaccination rates.

METHOD

This study will be conducted as a two-tiered cluster of randomized controlled trials over three months. Initially, 32 vaccination clinics will be randomly allocated to one of two study arms: (a) implementation of RVP or (b) no implementation. At the end of the study period, differences in influenza vaccination status between the intervention and control groups will be compared (primary outcome). Subsequently, a cluster randomized factorial trial will be conducted, involving 16 clinics implementing RVP. This trial will aim to compare the impact of various implementation strategies (different combinations of incentives) on fidelity in RVP implementation (primary outcome). Data collection for the primary outcomes will include unannounced exit interviews. Modified Poisson regression models and generalized linear mixed-effects models will be utilized to analyze the association between primary outcomes and interventions.

CONCLUSION

The study aims to enhance the influenza vaccination rate in China by developing financial and non-financial incentives that allow vaccination staff to deliver RVP with greater motivation. Furthermore, the evidence generated from this multi-center trial will assist policymakers in improving current incentive systems within immunization services.

TRIAL REGISTRATION

Chinese Clinical Trial Registry. Trial identifier: ChiCTR2400091302 (Registration Date: October 25, 2024); ChiCTR2400091324 (Registration Date: October 25, 2024).

The word learning dynamic assessment protocol (WorLDAP): Exploring speech-language pathologists' perceptions of the acceptability of a novel assessment tool

PURPOSE

Few resources are available to support speech-language pathologists (SLPs') dynamic assessment of vocabulary with school-aged children. We developed the Word Learning Dynamic Assessment Protocol (currently undergoing pilot testing). Framed by implementation science, in the current study we worked with speech-language pathologists to explore their perspectives on the acceptability of the Word Learning Dynamic Assessment Protocol.

METHOD

Eight speech-language pathologists who work with school-aged children watched a video demonstration of the Word Learning Dynamic Assessment Protocol being administered with a 6-year-old child and were then interviewed to share their thoughts on the Word Learning Dynamic Assessment Protocol's acceptability.

RESULT

Six themes were generated using reflexive thematic analysis: 1) Structure, scripting, and resourcing builds confidence in speech-language pathologists, 2) gaining important insight into the learning process, 3) flexible assessment supports child engagement and diversity, 4) family buy-in is created with clear communication, 5) a worthwhile investment of time?, and 6) building a more tailored assessment.

CONCLUSION

The speech-language pathologists who took part in this study valued the structure and resourcing of the Word Learning Dynamic Assessment Protocol as a way of supporting their ability to evaluate a child's strengths and challenges in vocabulary development in an engaging and individually tailored manner. Suggestions for further development will guide task refinement to meet the needs of speech-language pathologists.

Interventions for subjective and objective social isolation among people living with HIV: A scoping review

Subjective and objective social isolation has been a globally significant public health issue for people living with HIV, yet little is known about the characteristics, effectiveness, and acceptability of available interventions. The purpose of this scoping review was to systematically identify and map the available evidence on interventions for subjective and objective social isolation among people living with HIV. We searched PubMed, Cochrane Library, Embase, Scopus, Social Sciences Citation Index, PsycArticles, CINAHL, ProQuest Dissertation & Theses Global, OpenGrey, Google Scholar, international trial registers, and websites for eligible studies from their inception to June 1, 2024. We included any studies that identified subjective or objective social isolation as a primary goal or outcome of an intervention for people living with HIV (≥18 years old). Two researchers independently conducted study selection, data extraction, and data analysis. A 'basic qualitative content analysis' approach was used to analyze the findings of the included studies. Of the 12762 records identified, 19 full-text studies involving 961 participants were included in this scoping review. Overall, we identified seven interventions for subjective and objective social isolation among people living with HIV, as well as their characteristics, including psychological therapy, support group intervention, online support community, peer mentorship, navigation-type intervention, activity intervention, and knowledge/skills development intervention. However, there was limited, mixed evidence on the effectiveness and acceptability of different interventions for subjective and objective social isolation among people living with HIV. More rigorously designed and large-scale randomized control trials are needed to support and enrich existing evidence further.

Protocol for a Field Trial of a Hearing and Vision Support Intervention for People Living in Long-Term Care in Australia

INTRODUCTION

Hearing and vision impairments are prevalent among residents in long-term care settings. Hearing and vision impairments frequently go unsupported, affecting residents' quality of life and healthcare costs. This paper describes the protocol for a pre-post evaluation and process evaluation of a pragmatic sensory support intervention (SSI) that was developed with residents, informal caregivers and long-term care workers.

METHODS AND ANALYSIS

A prospective pre-post-intervention trial within long-term care will be conducted, including three groups: residents (n = 87), informal caregivers (n = 87) and long-term care workers (n = 40). Outcome measures include health-related quality of life and well-being measures relevant to each group measured at baseline, 3- and 6-months post-intervention. Health resource and sensory device utilisation will be captured from routine data and by direct observation. Qualitative interviews, including a representative sample of residents and informal caregivers, will be conducted as part of a simultaneous process evaluation. Generalised linear models and paired t-tests will be used to evaluate the effects on residents' and caregivers' quality of life and sensory device use. The cost-effectiveness of the intervention will be examined using within-trial analysis, economic modelling and budget impact assessment. A process evaluation will use descriptive statistics and thematic analysis to assess the intervention's reach, adoption, implementation, acceptability, mechanisms of change and contextual influences.

CONCLUSION

Hearing and vision impairments are common but under-supported in older adults in long-term care. This protocol involves a systematic evaluation of the effectiveness and implementation challenges of a pragmatic SSI to optimise hearing and vision function and improve the quality of life for long-term care residents and their caregivers.

Personalizing rehabilitation for individuals with musculoskeletal impairments: Feasibility of implementation of the Measures Associated to Prognostic (MAPS) tool

INTRODUCTION

The Measures Associated to PrognoStic (MAPS) tool is a standardized questionnaire that integrates validated prognostic tools to detect the presence of biopsychosocial prognostic factors in patients consulting for musculoskeletal disorders.

PURPOSE

The objectives were to assess the: 1) feasibility of implementation of the MAPS tool, 2) clinicians' acceptability of the dashboard, and 3) patients' acceptability of the MAPS tool.

METHODS

Twenty physiotherapists and two occupational therapists from seven outpatient musculoskeletal clinics were recruited to implement the MAPS tool during a 3-month timeframe, where new patients completed the questionnaire upon initial assessment. The results were presented to the clinicians via a dashboard. Surveys and semi-structured interviews were conducted to measure feasibility and acceptability.

RESULTS

Six out of 11 feasibility criteria (55%) and 21 out of 24 acceptability criteria (88%) reached the a priori threshold for success. The interviews allowed us to identify three main themes to facilitate implementation: 1) limiting the burden, 2) ensuring patients' understanding of the tool's purpose, and 3) integrating the dashboard as a clinical information tool.

CONCLUSION

Our quantitative and qualitative results support the feasibility of implementation and acceptability of the MAPS tool pending minor adjustments. Depicting the patients' prognostic profile has the potential to help clinicians optimize their interventions for patients presenting with musculoskeletal disorders.

The Acceptability of Psychedelic-Assisted Therapy Amongst Mental Health Consumers: Utilising the Theory of Planned Behaviour

Australian government approval has been granted for 3,4-methylenedioxy-methamphetamine (MDMA) treatment of post-traumatic stress disorder and psilocybin for treatment-resistant depression, but the process of translating psychedelic-assisted therapies (PAT) into more widespread use is complex. Along with establishing the efficacy and feasibility of PATs, their acceptability amongst consumers is a crucial factor of successful implementation. This study utilised the Theory of Planned Behaviour to evaluate the acceptability of PATs amongst mental health consumers, identifying potential influences of these attitudes and predictors of PAT uptake. Participants completed an online survey between February and July 2023. Survey items evaluated consumer characteristics, acceptability of PAT (effectiveness, efficacy and social norms) and behavioural intentions to undertake PAT. The 254 participants had a mean age of 42.5 years (SD = 12.8) and 79.1% were female. Three quarters expressed a desire to access PAT. Acceptability scores indicated strong agreement regarding the effectiveness of PAT, social norms that moderately endorsed PAT and mixed feelings about its expected efficacy. Whilst univariate analyses indicated that previous psychedelic experience was associated with increased acceptability of PAT (ds = 0.63-0.80), multivariate analyses revealed that intentions to access PAT were associated with higher acceptability scores (ds = 0.37-1.32) and poorer experiences of conventional therapy (d = -0.31). Although a relatively large portion of participants had used psychedelics recreationally, the desire to access PATs was more strongly related to its acceptability, along with more negative experiences of conventional therapy. This implies that mental health consumers who are looking for alternatives to conventional therapy may view PATs as a desirable option, despite some safety reservations.

The effectiveness and acceptability of formal versus informal mindfulness among university students with and without recent self-injury: A randomized controlled trial

Mindfulness instruction comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. FM involves sustaining attention on thoughts, emotions and bodily sensations through structured practices, while IM involves incorporating mindfulness into daily activities. However, recent evidence suggests that FM may pose challenges for students with recent non-suicidal self-injury (NSSI), whereas the flexibility and brevity inherent in IM may be better tolerated. This randomized controlled trial compared a FM induction, IM induction and control task among university students with (n = 103) and without (n = 123) past-year NSSI in terms of acceptability and pre-post state mindfulness, stress and well-being. Notably, results did not differ as a function of NSSI history. Two-way ANOVAs revealed that only IM was consistently preferred over the control task. Furthermore, three-way mixed ANOVAs revealed that-when assessed using brief Visual Analogue Scales-state well-being increased in all conditions, state mindfulness increased after both IM and FM, and state stress only decreased after IM. Notably, these differences by condition appeared to be of short duration as they were not found with lengthier measures. Results highlight the potential promise of IM and the importance of measurement selection when assessing the transient effects of mindfulness inductions in research.

Telehealth group intervention for adolescents and young adults with cancer: a feasibility pilot study protocol

BACKGROUND

Providing opportunities for social interaction and access to psychosocial interventions are 2 of the 15 Standards for Psychosocial Care for Children with Cancer and Their Families. Peer relationships are especially important among adolescents and young adults (AYAs), and cancer disrupts this aspect of social development. Many AYAs with cancer report a desire to engage in peer support groups; however, this remains a critical unmet need. Telehealth is a cost-effective and increasingly common modality for delivering health care that reduces access barriers and may be an especially good fit for AYAs with cancer. Little work has evaluated the feasibility and acceptability of peer support groups for AYAs with cancer. The purpose of this study is to evaluate the feasibility and acceptability of a telehealth peer support group intervention for AYAs with cancer.

METHODS

Telehealth group interventions are offered twice yearly as standard of care at Seattle Children's Hospital to AYAs on or off treatment for cancer or a brain tumor. Group members are assigned to a High School Group (grades 9-12) or an AYA Group (spring of grade 12 or older). Aim 1 is to determine the feasibility and acceptability of the intervention for all patients who participate in groups in their clinical care. Feasibility will be assessed based on a priori metrics (enrollment, attendance, attrition) for all group members. Group and telehealth acceptability will be assessed by a 16-item internally developed measure that was adapted from the Client Satisfaction Questionnaire. Aim 2 is to conduct patient stakeholder semi-structured interviews post-intervention with 20 AYAs to gather feedback and inform intervention refinement. Participants who opt-in for study procedures will also complete exploratory measures of social connectedness/isolation, depression, and benefit finding, pre- and post-intervention (Aim 3).

DISCUSSION

Findings from this pilot study will inform intervention refinement, intervention implementation, and sample sizes for future powered trials. This study will provide preliminary empirical evidence to support the development of effective group interventions for AYAs with cancer that increase opportunities for social interaction and access to peer support, with the potential to contribute to improved psychosocial care of AYAs with cancer.

The acceptability of a novel seismocardiography device for measuring VO2 max in a workplace setting: a mixed methods approach

BACKGROUND

Workplace health screening rarely includes measures of cardiorespiratory fitness, despite it being a greater predictor of cardiovascular disease and all-cause mortality than other routinely measured risk factors. This study aimed to determine the comparative acceptability of using a novel seismocardiography device to measure cardiorespiratory fitness via VO2 max during a workplace health check.

METHODS

Participants were invited to participate in workplace health screening sessions where VO2 max was assessed by both seismocardiography at rest and sub-maximal exercise testing, in order for acceptability of both to be compared across multiple domains. Questionnaires and focus group guides for participants and practitioners were developed based on the Theoretical Framework of Acceptability. Data were analysed using t-tests and deductive thematic analysis.

RESULTS

There was a significant difference in the acceptability domain of 'affective attitude' between the novel SCG device (M = 9.06 ± 1.14) and the sub-maximal exercise testing (M = 7.94 ± 1.79); t = 3.296, p = .001, d = 0.50, and in the domain of 'burden' between the novel SCG device (M = 9.16, ± 0.55) and the sub-maximal exercise testing (M = 7.41 ± 1.45); t = 7.033, p = < 0.001, d = 1.45. Practitioners and employees highlighted the potential of seismocardiography to create a more inclusive and accessible workplace offer, allowing those with restricted mobility or those with differing physical or emotional needs to participate in wellness testing; yet there was a lack of understanding in both groups around intervention effectiveness and coherence.

CONCLUSIONS

Seismocardiography may offer an acceptable route to cardiorespiratory fitness testing in the workplace, due to the low effort requirement and simplicity of administration. This study suggests that practitioners delivering such services have a critical role to play in acceptability of health interventions at work, as employees will be heavily influenced by practitioner beliefs around coherence and effectiveness. Comprehensive delivery training is important for the adoption of new health-related technologies such as seismocardiography into workplace health screening.

Efficacy of the Foodbot Factory digital curriculum-based nutrition education intervention in improving children's nutrition knowledge, attitudes and behaviours in elementary school classrooms: protocol for a cluster randomised controlled trial

INTRODUCTION

Schools are an important setting for supporting children's development of food literacy, but minimal research has assessed which strategies are most suitable for school nutrition education. The Foodbot Factory intervention, consisting of serious game (ie, a digital game designed for education) and curriculum-based lesson plans, was developed to support teachers and children ages 8-12 with nutrition education. Pilot data have demonstrated that Foodbot Factory can significantly improve children's nutrition knowledge, but it has not yet been evaluated in classrooms.

METHODS AND ANALYSIS

A single-blinded cluster randomised controlled trial was designed in 2022 by a research team based at Ontario Tech University to determine the efficacy of the Foodbot Factory intervention in improving children's nutrition knowledge, attitudes and behaviours. 32 grade 4 and 4/5 classrooms in Ontario will be randomised to receive (1) the Foodbot Factory intervention or (2) a control nutrition education intervention using conventional materials (eg, activity sheets). The study's primary outcome is to determine the overall nutrition knowledge acquired from the intervention. Secondary outcomes include nutrition knowledge subscores (ie, knowledge of specific food groups), nutrition attitudes, dietary intake, general nutrition behaviours (eg, eating breakfast) and intervention acceptability. An Ontario-certified teacher will deliver the intervention to both groups for 35-40 min/day for five consecutive days. Outcomes will be assessed at baseline, immediately postintervention, and 4 weeks and 3 months postintervention using the Nutrition Attitudes and Knowledge questionnaire, the Block Kids Food Screener, a modified Family Nutrition and Physical Activity screener and an acceptability questionnaire. Generalised linear mixed models will assess changes in outcomes between groups.

ETHICS AND DISSEMINATION

The study protocol is approved by research ethics boards at Ontario Tech University and participating school boards. Results of the trial will be published in peer-reviewed journals and lay summaries will be available to stakeholders.

TRIAL REGISTRATION NUMBER

NCT05979259.

Knowledge translation and exercise for degenerative meniscal pathology and early osteoarthritis (KNEE-DEeP): Protocol for a single arm feasibility study

Background

The Knowledge Translation and Exercise for Degenerative Meniscal Pathology and Early Knee Osteoarthritis (KNEE-DEeP) intervention was designed to promote greater uptake of evidence-based non-surgical treatments for knee pain attributed to degenerative meniscal pathology and early knee osteoarthritis (OA) in primary care, by tackling barriers at a service, clinician and patient level. Evidence indicates that patients frequently do not access first-line treatments, namely exercise and patient education, prior to specialist referral. The KNEE-DEeP intervention supports general practitioners (GPs) and physiotherapists to enhance their skills and confidence in managing patients with this type of knee pain through professional development workshops. In turn, patients will receive an 'enhanced consultation' from their GP and be referred to an early 'best practice' physiotherapy session. Physiotherapists will work with patients to develop a collaborative action plan focussing on self-management and exercise.

Methods

This protocol outlines a single arm non-randomised feasibility study with a mixed method process evaluation. The study intends to recruit 15 GPs, five physiotherapists and 36 patients from general practices in the South-West of Ireland. Eligible patients, will be aged between 35 years and 69 years inclusive, and attend their GP with an episode of non-traumatic knee pain attributed to a degenerative meniscal tear (DMT) or early OA. Physiotherapists and GPs will be trained in intervention delivery. Within two weeks of receiving an 'enhanced consultation' from their participating GP, patients will attend the one-hour 'best practice' physiotherapy session. Patient data will be collected via online questionnaires at baseline, 12 weeks and 6 months. Qualitative interviews to assess the feasibility and acceptability of the intervention will be conducted with a purposive sample of GPs, physiotherapists and their enrolled patients.

Ethics and Dissemination

Approved by Clinical Research Ethics Committee of the Cork Teaching Hospitals. Results will be presented in peer-reviewed journals and at international conferences.

Registration

clinicaltrials.gov ( NCT06576557).

A Pilot Intervention to Prevent Financial Exploitation

OBJECTIVES

Based on previous empirical research on financial stressors and resources and using a prevention science framework, this pilot study examined the effect and acceptability of a three-session older adult financial exploitation prevention intervention.

METHODS

Forty-five older adults participated in the study. Each participant completed three 30- to 45-minute sessions. The sessions included financial exploitation vulnerability, financial literacy, techniques used by scammers, choosing a trusted advocate, and creating a financial inventory. At the end of each session, participants were asked how relevant and trustworthy the information presented was. Primary outcome measures were financial vulnerability and financial literacy. Secondary outcomes were other mental health and stress factors, as well as how many participants reported choosing a trusted advocate and creating a financial inventory.

RESULTS

Financial literacy and financial vulnerability scores after the prevention intervention differed significantly from baseline scores. Participants' ratings after each session, with respect to usefulness and trustworthiness, were extremely positive.

CONCLUSIONS

The financial exploitation prevention intervention program demonstrated acceptability and a positive effect on reducing vulnerability to financial exploitation.

CLINICAL IMPLICATIONS

Proper assessment of an older client's financial history and of plans to safeguard their financial future is integral to the overall well-being and health of older clients.