Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies

BACKGROUND

The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use.

OBJECTIVE

We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community.

METHODS

We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences.

RESULTS

Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001).

CONCLUSIONS

Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults.

TRIAL REGISTRATION

PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.

Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review

BACKGROUND

Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations.

OBJECTIVE

This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users.

METHODS

This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid).

RESULTS

A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52).

CONCLUSIONS

As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven.

Providing compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses' experiences

Objective

Virtual care presents a promising opportunity to create new communication channels and increase access to healthcare. However, concerns have been raised around the potential for unintended emotional distances created through virtual care environments that could strain patient-provider relationships. While compassionate care is an enabler of emotional connectivity and a core tenant of nursing, little is known about whether or how nurses have adapted their compassion skills into virtual interactions. These concerns are particularly relevant in primary care, where there is a focus on relational continuity (i.e. relationship-based, longitudinal care) and a broad uptake of virtual care. The aim of this study was to explore the meaning of compassionate virtual care and to uncover how nurses operationalized compassionate care through virtual interactions in primary care.

Methods

We used a qualitative interpretive descriptive lens to conduct semistructured interviews with primary care nurses (Ontario, Canada) who had provided virtual care (i.e. video visits, remote patient monitoring, or asynchronous messaging). We used a thematic approach to analyze the data.

Results

We interviewed 18 nurse practitioners and two registered nurses. Participants described how: (1) compassionate care was central to nursing practice, (2) compassionate care was evolving through virtual nurse-patient interaction, and (3) nurses balanced practice with patients' expectations while providing virtual compassionate care.

Conclusions

There is an opportunity to better align nurses' understanding and operationalization of compassionate care in virtual primary care contexts. Exploring how compassionate care is operationalized in primary care settings is a necessary first step to building compassionate competencies across the nursing profession to support the continued virtual evolution of health service delivery.

Understanding Whether and How a Digital Health Intervention Improves Transition Care for Emerging Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Realist Evaluation

BACKGROUND

Emerging adults living with type 1 diabetes (T1D) face a series of challenges with self-management and decreased health system engagement, leading to an increased risk of acute complications and hospital admissions. Effective and scalable strategies are needed to support this population to transfer seamlessly from pediatric to adult care with sufficient self-management capability. While digital health interventions for T1D self-management are a promising strategy, it remains unclear which elements work, how, and for which groups of individuals.

OBJECTIVE

This study aims to evaluate the design and implementation of a multicomponent SMS text message-based digital health intervention to support emerging adults living with T1D in real-world settings. The objectives are to identify the intervention components and associated mechanisms that support user engagement and T1D health care transition experiences and determine the individual characteristics that influence the implementation process.

METHODS

We used a realist evaluation embedded alongside a randomized controlled trial, which uses a sequential mixed methods design to analyze data from multiple sources, including intervention usage data, patient-reported outcomes, and realist interviews. In step 1, we conducted a document analysis to develop a program theory that outlines the hypothesized relationships among "individual-level contextual factors, intervention components and features, mechanisms, and outcomes," with special attention paid to user engagement. Among them, intervention components and features depict 10 core characteristics such as transition support information, problem-solving information, and real-time interactivity. The proximal outcomes of interest include user engagement, self-efficacy, and negative emotions, whereas the distal outcomes of interest include transition readiness, self-blood glucose monitoring behaviors, and blood glucose. In step 2, we plan to conduct semistructured realist interviews with the randomized controlled trial's intervention-arm participants to test the hypothesized "context-intervention-mechanism-outcome" configurations. In step 3, we plan to triangulate all sources of data using a coincidence analysis to identify the necessary combinations of factors that determine whether and how the desired outcomes are achieved and use these insights to consolidate the program theory.

RESULTS

For step 1 analysis, we have developed the initial program theory and the corresponding data collection plan. For step 2 analysis, participant enrollment for the randomized controlled trial started in January 2023. Participant enrollment for this realist evaluation was anticipated to start in July 2023 and continue until we reached thematic saturation or achieved informational power.

CONCLUSIONS

Beyond contributing to knowledge on the multiple pathways that lead to successful engagement with a digital health intervention as well as target outcomes in T1D care transitions, embedding the realist evaluation alongside the trial may inform real-time intervention refinement to improve user engagement and transition experiences. The knowledge gained from this study may inform the design, implementation, and evaluation of future digital health interventions that aim to improve transition experiences.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/46115.

Empathy training for service employees: A mixed-methods systematic review

Following the surge for empathy training in service literature and its increasing demand in service industries, this study systematically reviews empirical papers implementing and testing empathy training programs in various service domains. A mixed-methods systematic review was performed to identify and describe empathy training programs and discuss their effectiveness in service quality, service employees' well-being, and service users' satisfaction. Included papers met those eligibility criteria: qualitative, quantitative, or mixed-methods study; one training in empathy is identifiable; described training(s) developed for or tested with service employees dealing with service users. We searched health, business, education, and psychology databases, such as CINAHL, Medline ABI/Inform Global, Business Source Premier, PsycINFO, and ERIC. We used the Mixed-Method Assessment Tool to appraise the quality of included papers. A data-based convergent synthesis design allowed for the analysis of the data. A total of 44 studies published between 2009 to 2022 were included. The narrative presentation of findings was regrouped into these six dimensions of empathy training programs: 1) why, 2) who, 3) what, 4) how, 5) where, and 6) when and how much. Close to 50% of studies did not include a definition of empathy. Four main empathic competencies developed through the training programs were identified: communication, relationship building, emotional resilience, and counseling skills. Face-to-face and group-setting interventions are widespread. Our systematic review shows that the 44 papers identified come only from health services with a predominant population of physicians and nurses. However, we show that the four empathic skills identified could be trained and developed in other sectors, such as business. This is the first mixed-methods, multi-disciplinary systematic review of empathy training programs in service research. The review integrates insights from health services, identifies research limitations and gaps in existing empirical research, and outlines a research agenda for future research and implications for service research.

Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review

BACKGROUND

Policymakers and program developers in low-and lower-middle-income countries (LLMICs) are increasingly seeking evidence-based information and guidance on how to successfully develop and implement continuing professional development (CPD) systems. We conducted a rapid scoping review to map and synthesize what is known regarding the development, implementation, evaluation and sustainability of CPD systems for healthcare professionals in LLMICs.

METHODS

We searched MEDLINE, CINAHL and Web of Science. Reference lists were screened and a cited reference search of included articles was conducted. Supplementary information on the CPD systems identified in the articles was also identified via an online targeted grey literature search. English, French and Spanish literature published from 2011 to 2021 were considered. Data were extracted and combined and summarized according to country/region and healthcare profession via tables and narrative text.

RESULTS

We included 15 articles and 23 grey literature sources. Africa was the region most represented followed by South and Southeast Asia and the Middle East. The literature most often referred to CPD systems for nurses and midwives; CPD systems for physicians were frequently referred to as well. Findings show that leadership and buy-in from key stakeholders, including government bodies and healthcare professional organizations, and a framework are essential for the development, implementation and sustainability of a CPD system in a LLMIC. The guiding framework should incorporate a regulatory perspective, as well as a conceptual lens (that informs CPD objectives and methods), and should consider contextual factors (support for CPD, healthcare context and population health needs). In terms of important steps to undertake, these include: a needs assessment; drafting of a policy, which details the regulations (laws/norms), the CPD requirements and an approach for monitoring, including an accreditation mechanism; a financing plan; identification and production of appropriate CPD materials and activities; a communication strategy; and an evaluation process.

CONCLUSION

Leadership, a framework and a clearly delineated plan that is responsive to the needs and context of the setting, are essential for the development, implementation and sustainability of a CPD system for healthcare professionals in a LLMIC.

Developing Implementation Strategies to Support the Uptake of a Risk Tool to Aid Physicians in the Clinical Management of Patients With Syncope: Systematic Theoretical and User-Centered Design Approach

BACKGROUND

The Canadian Syncope Risk Score (CSRS) was developed to improve syncope management in emergency department settings. Evidence-based tools often fail to have the intended impact because of suboptimal uptake or poor implementation.

OBJECTIVE

In this paper, we aimed to describe the process of developing evidence-based implementation strategies to support the deployment and use of the CSRS in real-world emergency department settings to improve syncope management among physicians.

METHODS

We followed a systematic approach for intervention development, including identifying who needs to do what differently, identifying the barriers and enablers to be addressed, and identifying the intervention components and modes of delivery to overcome the identified barriers. We used the Behaviour Change Wheel to guide the selection of implementation strategies. We engaged CSRS end users (ie, emergency medicine physicians) in a user-centered design approach to generate and refine strategies. This was achieved over a series of 3 qualitative user-centered design workshops lasting 90 minutes each with 3 groups of emergency medicine physicians.

RESULTS

A total of 14 physicians participated in the workshops. The themes were organized according to the following intervention development steps: theme 1-identifying and refining barriers and theme 2-identifying the intervention components and modes of delivery. Theme 2 was subdivided into two subthemes: (1) generating high-level strategies and developing strategies prototypes and (2) refining and testing strategies. The main strategies identified to overcome barriers included education in the format of meetings, videos, journal clubs, and posters (to address uncertainty around when and how to apply the CSRS); the development of a web-based calculator and integration into the electronic medical record (to address uncertainty in how to apply the CSRS); a local champion (to address the lack of team buy-in); and the dissemination of evidence summaries and feedback through email communications (to address a lack of evidence about impact).

CONCLUSIONS

The ability of the CSRS to effectively improve patient safety and syncope management relies on broad buy-in and uptake across physicians. To ensure that the CSRS is well positioned for impact, a comprehensive suite of strategies was identified to address known barriers.

Understanding how virtual care has shifted primary care interactions and patient experience: A qualitative analysis

INTRODUCTION

The widespread and rapid implementation of virtual care has introduced evolutionary changes in the context, process, and way primary care is delivered. The objectives of this study were to: (1) understand whether and how virtual care has shifted the therapeutic relationship; (2) describe the core components of compassionate care from the patient perspective and (3) identify how and in what circumstances compassionate care might be amplified.

METHODS

Participants living in Ontario, Canada were eligible if they had interacted with their primary care clinician following the rapid implementation of virtual care in March 2020, irrespective of virtual care use. One-on-one semi-structured interviews were conducted with all participants and data were analyzed using inductive thematic analysis.

RESULTS

Four themes emerged across 36 interviews: (1) Virtual care shifts communication patterns but the impact on the therapeutic relationship is unclear; (2) Rapid implementation of virtual care limited perceived quality and access among those who did not have the option to utilize it; (3) Patients perceive five key elements as central to compassion in a virtual context; and (4) Leveraging technology to fill gaps within and beyond the visit is a step towards improving experiences for all.

DISCUSSION

Virtual care has transformed the ways in which patient-clinician communication operates in primary care. Patients with access to virtual care described largely positive experiences, while those whose interactions were limited to phone visits experienced decreased quality and access to care. Attention must shift to identifying effective strategies to support the health workforce in building virtual compassion competencies.

The Relational Virtual Nursing Practice Model: A Web-Based Nursing Intervention

This discussion paper aimed to reflect on the development of relational connections in the context of a web-based, tailored, asynchronous nursing intervention (VIH-TAVIETM) aimed at empowering people living with HIV in taking their antiretroviral treatment. Our reflection culminates in the Relational Virtual Nursing Practice Model. This paper builds on nurse-researchers and people living with HIV's experiences, nursing theories, and cross-disciplinary work on relational engagement. The model shows the disciplinary principles underpinning VIH-TAVIETM, engagement processes used to create humanistic and supportive relational environment and people's relational experiences and it contributes to the development of conceptual nursing knowledge on how generating meaningful relational nursing care in virtual environments.

Nurses' clinical practices reducing the impact of HIV-related stigmatisation in non-HIV-specialised healthcare settings: a protocol for a realist synthesis

INTRODUCTION

Despite tremendous progress in care, people living with HIV (PLHIV) continue to experience HIV-related stigmatisation by nurses in non-HIV-specialised healthcare settings. This has consequences for the health of PLHIV and the spread of the virus. In the province of Quebec (Canada), only four interventions aimed at reducing the impact of HIV-related stigmatisation by nurses have been implemented since the beginning of the HIV pandemic. While mentoring and persuasion could be promising strategies, expression of fears of HIV could have deleterious effects on nurses' attitudes towards PLHIV. In literature reviews on stigma reduction interventions, the contextual elements in which these interventions have been implemented is not considered. In order to develop new interventions, we need to understand how the mechanisms (M) by which interventions (I) interact with contexts (C) produce their outcomes (O).

METHODS AND ANALYSIS

Realist synthesis (RS) was selected to formulate a programme theory that will rely on CIMO configuration to describe (1) nursing practices that may influence stigmatisation experiences by PLHIV in non-HIV-specialised healthcare settings, and (2) interventions that may promote the adoption of such practices by nurses. The RS will draw on the steps recommended by Pawson: clarify the scope of the review; search for evidence; appraise primary studies and extract data; synthesise evidence and draw conclusions. To allow an acute interpretation of the disparities between HIV-related stigmatisation experiences depending on people's serological status, an initial version of the programme theory will be formulated from data gathered from scientific and grey literature, and then consolidated through realist interviews with various stakeholders (PLHIV, nurses, community workers and researchers).

ETHICS AND DISSEMINATION

Ethical approval for realist interviews will be sought following the initial programme theory design. We intend to share the final programme theory with intervention developers via scientific publications and recommendations to community organisations that counter HIV-related stigmatisation.

[French translation, cultural adaptation and assessment of preliminary psychometric properties of the Protective Behavioral Strategies for Marijuana Scale]

OBJECTIVE

Young adults (18- to 24-year-olds) constitute the age group with the highest proportion of cannabis users. In the context of legalization, it is important to promote lower-risk cannabis use. The Protective Behavioral Strategies for Marijuana Scale (PBSM-17) identifies strategies used by consumers. However, this scale is not available in French and is not adapted to the Canadian context. This article presents the process that led to the translation, cultural adaptation and evaluation of the preliminary psychometric properties of PBSM-17.

METHOD

The methodological study was carried out in six steps. The first four steps led to the translation towards French and adaptation of the scale. A validation among 12 young people contributed to establish the criterion equivalency (step 5). The evaluation of psychometric properties (step 6) was carried out among 211 bilingual university students (61 % women; mean age 22 years old).

RESULTS

The French version presents satisfactory preliminary psychometric properties: internal consistency is acceptable (α = 0.88); criterion equivalency was established between the French and the original English version (t (210) = 1.04, p = 0.30; 95% CI [-0.20, 0.63]). The scores obtained on both versions by the same participant were found to be strongly correlated (r = 0.95, p <0.001).

CONCLUSION

The results support the use of the French version of PBSM-17. The proposed protective strategies can be used as a measurement tool and represent behaviors that can be targeted in a lower-risk cannabis use context.

Psychometric properties of the French and English short form of the Protective Behavioural Strategies for Marijuana Scale in Canadian university students

BACKGROUND

The Protective Behavioural Strategies for Marijuana (PBSM-17) scale serves to identify and measure strategies employed by young adults before, during or after cannabis use. After the adaptation and translation of the PBSM-17 into French, a methodological study was conducted to evaluate the psychometric properties of this French version (FV) and of the original English version (EV) in a sample of bilingual Canadian university students.

METHODS

A total of 211 cannabis users (mean age=22.1 years) completed a sociodemographic questionnaire, a question on frequency of cannabis use (four categories: 1-3 times a month, once a week, more than once a week, everyday) and both versions (FV and EV) of the PBSM-17.

RESULTS

Both versions had similar internal reliability (α=0.91; α=0.88). The one-factor solution explained 36.46% of the variance for the FV and 42.26% for the EV. As hypothesised, greater use of protective behavioural strategies was related to lower frequency of cannabis use. One-way ANOVA test results revealed a statistically significant difference in use of strategies by frequency of cannabis use for both the FV (F(3, 207)=27.38, p<0.001) and EV (F(3, 207)=29.32, p<0.001). Post hoc comparisons showed that everyday users employed fewer strategies on average than lower-frequency users.

CONCLUSION

The FV and EV of the PBSM-17 demonstrated satisfactory psychometric properties. The proposed FV of the PBSM-17 is a reliable instrument that could be used for research and clinical purposes. Protective behavioural strategies can serve as indicator of lower-risk cannabis use and could be targeted in prevention interventions.

Psychological distress, depression symptoms and fatigue among Quebec nursing staff during the COVID-19 pandemic: A cross-sectional study

Aim

To describe the state of health of Quebec nursing staff during the pandemic according to their exposure to COVID‐19, work‐related characteristics and sociodemographic factors (gender, generational age group). State of health was captured essentially by assessing psychological distress, depression symptoms and fatigue.

Design and methods

A large‐scale cross‐sectional study was conducted with 1,708 nurses and licenced practical nurses in Quebec (87% women, mean age of 41 ± 11 years). The survey included several questionnaires and validated health‐related scales (psychological distress, depression symptoms and fatigue). The STROBE guidelines were followed in reporting the study's findings.

Results

Results showed that the prevalence of psychological distress and depression symptoms was moderate to severe. Women, generation Xers and Yers, nurses who cared for COVID‐19 patients and those with a colleague who was infected with COVID‐19 at work scored higher for fatigue, psychological distress and depression.

Virtual patient simulation to improve nurses' relational skills in a continuing education context: a convergent mixed methods study

BACKGROUND

Effective provider-patient communication is crucial to the delivery of high-quality care. Communication roadblock such as righting reflex is widely observed among providers and can lead to relational disengagement. In previous work, nurses felt ill-equipped to communicate effectively with HIV-positive patients to support medication adherence. Providing nurses with continuing education opportunities to improve their relational skills is a major target for optimizing the quality of care. Virtual patient simulation is one promising strategy that needs to be evaluated among graduate nurses. This study aimed to assess the acceptability of a virtual patient simulation to improve nurses' relational skills in a continuing education context.

METHODS

We conducted a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select registered nurses (n = 49) working in Quebec, Canada. Participants completed an online sociodemographic questionnaire, consulted the automated virtual patient simulation (informed by motivational interviewing), and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. At the final stage of the study, we used a comparison strategy for the purpose of integrating the quantitative and qualitative results.

RESULTS

Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research.

CONCLUSIONS

The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses' self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care.

TRIAL REGISTRATION

ISRCTN18243005 , retrospectively registered on July 3 2020.

Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol

BACKGROUND

The Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education is an innovative guided-practice model aiming at amplifying healthcare professionals' competencies in the management of chronic and complex health conditions. While data on the impact of the ECHO model is increasingly available in the literature, what influences the model effectiveness remains unclear. Therefore, the overarching aim of this systematic review is to identify, appraise, and synthesize the available quantitative (QUAN) and qualitative (QUAL) evidence regarding the ECHO Model effectiveness and the experiences/views of ECHO's participants about what influences the development of competencies in healthcare professionals.

METHODS

The proposed systematic review was inspired by the Joanna Briggs Institute (JBI) methodology for Mixed Methods Systematic Reviews (MMSR) and will follow a convergent segregated approach. A systematic search will be undertaken using QUAN, QUAL and mixed methods (MM) studies of ECHO-affiliated programs identified in six databases. A publication date filter will be applied to find the articles published from 2003 onwards. Sources of unpublished studies and gray literature will be searched as well. Retrieved citations will independently be screened by two reviewers. Disagreements will be resolved through discussion until a consensus is reached or by including a third reviewer. Studies meeting the predefined inclusion criteria will be assessed on methodological quality and the data will be extracted using standardized data extraction forms. Separate QUAN and QUAL synthesis will be performed, and findings will be integrated using a matrix approach for the purpose of comparison and complementarity.

DISCUSSION

This MMSR will fulfill important gaps in the current literature on the ECHO Model as the first to provide estimates on its effectiveness and consider simultaneously the experiences/views of ECHO's participants. As each replication of the ECHO Model greatly varies depending on the context, topic, and targeted professionals, a better understanding of what influences the model effectiveness in developing healthcare professionals' competencies is crucial to inform future implementation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020197579.

Impact of a videoconferencing educational programme for the management of concurrent disorders on nurses' competency development and clinical practice: protocol for a convergent mixed methods study

INTRODUCTION

Extension for Community Healthcare Outcomes (Project ECHO©) is an innovative model for continuing professional development that uses videoconferencing technology to support and train general practitioners remotely. The model has been replicated to a variety of settings and locations for capacity building in healthcare professionals caring for patients with chronic and complex health conditions. Limited research has been conducted so far on the impact of ECHO in the field of concurrent mental health and substance use disorders (ie, concurrent disorders (CDs)). Therefore, this mixed methods study aims to develop a comprehensive understanding of an ECHO programme impact for CD management on nurses' competency development and clinical practice.

METHODS AND ANALYSIS

The proposed mixed methods study, based on a convergent parallel design, will be conducted in the province of Quebec, Canada, to collect, analyse and interpret quantitative (QUAN) and qualitative (QUAL) data from a specific ECHO Program on CDs. In the QUAN component, an observational prospective cohort study will be conducted over a 12-month period. All nurses who participated in the programme between 2018 and 2020 and who consent to research will be recruited to collect data on the extent of their learning and practice outcomes at three time points. Alongside the surveys, nurses will be invited to participate in individual semistructured interviews. In-depth QUAL data will be subjected to a thematic analysis and will assist in exploring how and in which conditions nurses developed and mobilised their competencies in clinical practice. A comparison-of-results strategy will be used in the final integration component of the study.

ETHICS AND DISSEMINATION

This study protocol was approved by the Ethics Committee of the Université de Montréal Hospital Center (#19.295) and the Université de Montréal Ethics Committee (CERSES-20-017 R). We aim to disseminate the findings through international academic conferences, international peer-reviewed journals and professional media.

Evaluation of a web-based virtual nursing intervention to support self-management among adults with epilepsy: A mixed-methods study

OBJECTIVE

A web-based intervention was developed to support epilepsy self-management. A mixed methods study was undertaken to evaluate the intervention's extent of utilization, acceptability and preliminary effects, and to assess user perception of it.

METHODS

First, a pilot parallel-group randomized controlled trial was conducted with a convenience sample of 75 adult with epilepsy who had Internet access allocated on a 1:1 ratio into an experimental group that received the intervention (experimental group (EG), n = 37) and a control group invited to consult epilepsy-related websites (control group (CG), n = 38). Self-management, knowledge, and quality of life (QoL) outcomes were measured at baseline and one and three months later. Descriptive statistics of extent of utilization and acceptability were computed. Linear mixed models were conducted to assess change in outcomes over time and between groups. Subsequently, an exploratory qualitative study was carried out with 15 EG participants. Qualitative data were subjected to thematic analysis.

RESULTS

Participants had a mean age of 40 years (range: 18-73), 45% were female, and mean time since diagnosis was 18 years (range: less than a year to 60 years). In the EG, 70% of the participants completed the intervention. Regarding acceptability, participants (n = 25) were satisfied overall (88%) and found content clear (92%) and the information reliable (100%). EG participants experienced greater improvement in QoL compared with CG participants, least-squares means (95% CI): 0.41 (0.06, 0.76). Three major themes emerged from the interviews (n = 15): intervention provides certain personal benefits; clinical content is of general interest but should be tailored; and intervention should target "new" patients early in the care trajectory.

DISCUSSION

The web-based intervention shows promise in terms of usefulness in enhancing QoL, and user experience showed that it is acceptable and helpful. It could constitute a complementary service in support of existing services for people with epilepsy and their families.

Codeveloping a Virtual Patient Simulation to Foster Nurses' Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence

Background

Although helping people living with HIV manage their antiretroviral therapy is a core competency of HIV nursing care, no educational intervention has sought to strengthen this competency. Thus, we codeveloped a simulation of a virtual patient (VP) having difficulty adhering to treatment to foster the relational skills that nurses require in such situations.

Objective

This viewpoint paper aims to describe the codevelopment process and the content of VP simulation, as well as the challenges encountered and the strategies used to overcome them.

Methods

We use a collaborative and iterative approach to develop the simulation based on qualitative evidence, theoretical approaches (strengths-based nursing, motivational interviewing [MI], and adult learning theories), and expert recommendations. We carried out 2 main phases: (1) planning the simulation development and (2) designing the simulation content, sequence, and format. We created the script as if we were writing a choose-your-own-adventure book. All relational skills (behavior change counseling techniques derived from MI) were integrated into a nurse-patient dialogue. The logic of the simulation is as follows: if the nurse uses techniques consistent with MI (eg, open-ended questions, summarizing), a dialogue is opened up with the VP. If the nurse uses relational skills inconsistent with MI (eg, providing advice without asking for permission), the VP will react accordingly (eg, defensively). Learners have opportunities to assess and reflect on their interventions with the help of quizzes and feedback loops.

Results

Two main challenges are discussed. The most salient challenge was related to the second phase of the VP simulation development. The first was to start the project with divergent conceptions of how to approach the VP simulation—the simulation company’s perspective of a procedural-type approach versus the clinical team’s vision of a narrative approach. As a broad strategy, we came to a mutual understanding to develop a narrative-type VP simulation. It meshed with our conception of a nurse-patient relationship, the values of strengths-based nursing (a collaborative nurse-patient relationship), and the MI’s counseling style. The second challenge was the complexity in designing realistic relational skills in preprogrammed and simulated nurse-patient dialogue while preserving an immersive learning experience. As a broad strategy, we created a collaborative and work-in-progress writing template as a shared working tool.

Conclusions

Our experience may be helpful to anyone looking for practical cues and guidance in developing narrative VP simulations. As relational skills are used by all nurses—from novices to experts—and other health care practitioners, focusing on this clinical behavior is a good way to ensure the simulation’s adaptability, sustainability, and efficiency.

Effectiveness of a Web-Based Intervention to Support Medication Adherence Among People Living With HIV: Web-Based Randomized Controlled Trial

Background

Taking antiretroviral therapy (ART) is part of the daily life of people living with HIV. Different electronic health (eHealth) initiatives adjunctive to usual care have been proposed to support optimal medication adherence. A web-based intervention called HIV Treatment, Virtual Nursing Assistance, and Education or VIH-TAVIE (from its French version Virus de l’immunodéficience humaine-Traitement assistance virtuelle infirmière et enseignement) was developed to empower people living with HIV to manage their ART and symptoms optimally.

Objective

We aimed to evaluate the effectiveness of VIH-TAVIE in a web-based randomized controlled trial (RCT).

Methods

This RCT was entirely web-based, including recruitment, consent granting, questionnaire completion, and intervention exposure (consultation with VIH-TAVIE [experimental group] or websites [control group]). To be eligible for the study, people living with HIV had to be 18 years or older, be on ART for at least 6 months, have internet access, and have internet literacy. Participants were randomly assigned to either the experimental group (n=45) or control group (n=43). The primary outcome was ART adherence. The secondary outcomes included self-efficacy regarding medication intake, symptom-related discomfort, skills and strategies, and social support. All outcomes were measured with a self-administered web-based questionnaire at the following three time points: baseline and 3 and 6 months later. A generalized linear mixed model was built to assess the evolution of ART adherence over time in both groups.

Results

The sample included 88 participants, and of these, 73 (83%) were men. The median age of the participants was 42 years. Participants had been diagnosed with HIV a median of 7 years earlier (IQR 3-17) and had been on ART for a median of 5 years (IQR 2-12). The proportion of treatment-adherent participants at baseline was high in both groups (34/41, 83% in the experimental group and 30/39, 77% in the control group). Participants also reported high treatment adherence, high self-efficacy, and high skills; perceived good social support; and experienced low discomfort from symptoms. Analyses revealed no intergroup difference regarding ART adherence (OR 1.9, 95% CI 0.6-6.4).

Conclusions

This study highlights the challenges and lessons learned from conducting an entirely web-based RCT among people living with HIV. The challenges were related to the engagement of people living with HIV on the following three levels: starting the web-based study (recruitment), completing the web-based intervention (engagement), and continuing the study (retention). The results contribute to the existing body of knowledge regarding how to conduct web-based evaluation studies of eHealth interventions aimed at developing and strengthening personal skills and abilities.

Trial Registration

ClinicalTrials.gov NCT01510340; https://clinicaltrials.gov/ct2/show/NCT01510340

Effect of implementation interventions on nurses' behaviour in clinical practice: a systematic review, meta-analysis and meta-regression protocol

BACKGROUND

Practitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses' behaviour in clinical practice and improve patients' health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes-i.e. mechanisms of action-targeted by interventions to change nurses' behaviour in clinical practice, and the constituent components-i.e. behaviour change techniques-included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses' behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques.

METHODS

We will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses' behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International's NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software.

DISCUSSION

This review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses' behaviour change in clinical practice. Results will provide key insights regarding which causal processes-i.e. mechanisms of action-should be targeted by these interventions, and which constituent components-i.e. behaviour change techniques-should be included in these interventions to increase their effectiveness.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).

Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews

Background

E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context.

Objective

We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context.

Methods

We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results).

Results

We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration.

Conclusions

The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714

Communicating Science in the Digital and Social Media Ecosystem: Scoping Review and Typology of Strategies Used by Health Scientists

Background

The public’s understanding of science can be influential in a wide range of areas related to public health, including policy making and self-care. Through the digital and social media ecosystem, health scientists play a growing role in public science communication (SC).

Objective

This review aimed to (1) synthesize the literature on SC initiated by health scientists targeting the public in the digital and social media ecosystem and (2) describe the SC strategies and communication channels used.

Methods

This scoping review was based on the Joanna Briggs Institute Methodological Framework. A systematic search was performed in 6 databases (January 2000 to April 2018). Title and abstract screening, full-text review, data charting, and critical appraisal were performed independently by two review authors. Data regarding included studies and communication channels were synthesized descriptively. A typology of SC strategies was developed using a qualitative and inductive method of data synthesis.

Results

Among 960 unique publications identified, 18 met inclusion criteria. A third of publications scored good quality (6/18, 33%), half scored moderate quality (9/18, 50%), and less than a fifth scored low quality (3/18, 16%). Overall, 75 SC strategies used by health scientists were identified. These were grouped into 9 types: content, credibility, engagement, intention, linguistics, planification, presentation, social exchange, and statistics. A total of 5 types of communication channels were identified: social networking platforms (eg, Twitter), content-sharing platforms (eg, YouTube), digital research communities (eg, ResearchGate), personal blogs and websites (eg, WordPress), and social news aggregation and discussion platforms (eg, Reddit).

Conclusions

Evidence suggests that multiple types of SC strategies and communication channels are used by health scientists concurrently. Few empirical studies have been conducted on SC by health scientists in the digital and social media ecosystem. Future studies should examine the appropriateness and effectiveness of SC strategies for improving public health–related outcomes and identify the barriers, facilitators, and ethical considerations inherent to the involvement of health scientists in the digital and social media ecosystem.

Nursing Practice to Support People Living With HIV With Antiretroviral Therapy Adherence: A Qualitative Study

Antiretroviral therapy (ART) management is a core competency for nursing practice in HIV as documented in best practice guidelines. Nurse-led interventions are effective in fostering ART adherence in people living with HIV (PLWH). However, these evidence-based interventions and professional expectations pertaining to these guidelines do not reflect current practice, nor do they expose the challenges faced by nurses. We conducted a qualitative exploratory study with nurses to explore their professional practices in the context of ART adherence. Sixteen nurses participated in data collection: nine in a focus group and seven in individual interviews. We identified four themes: building a therapeutic relationship with PLWH as a foundation of HIV nursing care; nursing activities to support PLWH with ART adherence; challenges faced by nurses providing ART-related care; and resource mobilization supporting nursing practice development in ART management and HIV care. Aspects of HIV nursing practice need to be strengthened to enhance best practice care, such as managing powerlessness in the context of ART nonadherence.

“What Is PER?” Patient Engagement in Research as a Hit

Engaging patients in research conduct and agenda setting is increasingly considered as an ethical imperative, and a way to transcend views of patients as passive subjects by fostering their empowerment. However, patient engagement in research (PER) is still an emerging approach with debated definitional and operational frameworks. This song addresses the sometimes difficult encounter and elusive mutual understanding between researchers and patients. “What is PER?” is an impressionistic illustration of the challenges and issues that can be found in the universe of patient engagement in research.

Barriers and facilitators to birth without epidural in a tertiary obstetric referral center: Perspectives of health care professionals and patients

BACKGROUND

Epidural rates are high in tertiary obstetric referral centers, even though many patients in tertiary settings might not want or need epidural analgesia. Epidural rates are influenced by factors including labor support and routine medical intervention. This study aimed to identify barriers and facilitators to birth without epidural in a Canadian tertiary center, from the perspectives of doctors, nurses, and patients.

METHODS

In this qualitative exploratory study, individual, semi-structured interviews were conducted in 2016 with 5 doctors, 5 nurses, and 4 patients who intended to birth without epidural. Interviews were audio-recorded, transcribed, and analyzed using inductive qualitative thematic analysis.

RESULTS

Several contextual factors in the tertiary center facilitated or were barriers to birth without epidural. The following themes emerged: (1) differing perceptions of pain, (2) being ready for things to go wrong, (3) labor support is more labor intensive, and (4) having insufficient resources for birth without epidural.

CONCLUSIONS

Reconciling patient birth goals with staff focus on patient safety is challenging in the tertiary context. Discrepancies between health care professional and patient attitudes about childbirth pain may influence decision-making about epidural use. Maintaining labor support skills is challenging for health care professionals who have limited exposure to birth without epidural. There is a need to allocate dedicated resources to better support birth without epidural. Specifically, support could be improved through the implementation of guidelines for assessment and management of labor pain, provision of a variety of pain management options, and labor support training for health care professionals.

Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial

Background

Optimal immunosuppressive medication adherence is essential to graft survival. Transplant-TAVIE is a Web-based tailored intervention developed to promote this adherence.

Objective

The objective of our study was to evaluate the Transplant-TAVIE intervention’s acceptability, feasibility, and preliminary efficacy.

Methods

In a pilot, parallel-group, randomized controlled trial, we randomly assigned a convenience sample of 70 kidney transplant patients on immunosuppressive medication either to an experimental group (Transplant-TAVIE) or to a control group (existing websites). Kidney transplant recipients had to be older than 18 years, be taking immunosuppressant medication, and have access to the internet to participate in this study. Transplant-TAVIE was composed of three interactive Web-based sessions hosted by a virtual nurse. We documented user appreciation of and exposure to the intervention. Furthermore, we assessed medication adherence, medication self-efficacy, intake-related skills, and medication side effects at baseline and 3 and 6 months later. Analyses of variance were used to assess intergroup differences over time.

Results

After baseline questionnaire completion, participants were randomly assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All participants had received their kidney graft <1 year to 32 years earlier (mean 6.8 years). Of the experimental group, 54% (19/35) completed the sessions of Transplant-TAVIE. Users found the intervention to be acceptable—33% were extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were satisfied (5/18). At baseline and over time, both experimental and control groups reported high medication adherence, high medication self-efficacy, and frequent use of skills related to medication intake. No intergroup differences emerged over time.

Conclusions

The results of this study support the feasibility and acceptability of Transplant-TAVIE. It could constitute an accessible adjunct in support of existing specialized services.

Clinical presentation of Lyme disease in the higher-risk region of Quebec: a retrospective descriptive study

BACKGROUND

Lyme disease is emerging in Canada. This study aimed to describe the use of serologic testing for the disease in the La Pommeraie health region in southern Quebec between 2012 and 2015 and to describe the clinical presentation of laboratory-confirmed cases.

METHODS

The medical charts of all patients investigated for Lyme disease at the Brome-Missisquoi-Perkins Hospital's laboratory between 2012 and 2015 were reviewed for results of serologic testing. Laboratory diagnosis was based on 2-tiered testing: cases had to have positive results of both the enzyme immunoassay and the Western blot test (IgM or IgG). We collected data on clinical presentation for patients assessed at the hospital or at the La Pommeraie Family Medicine Unit.

RESULTS

Over the study period, 720 patients were investigated for Lyme disease. There was a more than fivefold increase in requests for serologic testing from 2012 (53) to 2015 (273). The number of confirmed cases increased from 2012 (3) to 2013 (19) and remained stable thereafter (19 in 2014, 18 in 2015). Fifty patients were positive for IgM with or without IgG positivity, and 9 patients were IgG-positive only. Chart reviews were completed for 278 of the 720 patients, including 38 of the 59 laboratory-confirmed cases. Among the 29 IgM-positive patients, the most common symptoms were fever (17 patients [59%]), fatigue (14 [48%]), myalgia (12 [41%]) and headaches (10 [34%]). Twenty-three (79%) had some cutaneous manifestation, including specifically erythema migrans (14 [48%]). A tick bite was reported by 11 patients (38%). Of the 44 patients in the entire study population who presented with erythema migrans, 15 (34%) had confirmed Lyme disease.

INTERPRETATION

Requests for serologic testing for Lyme disease increased in the La Pommeraie health region over recent years. Cutaneous manifestations, fever and myalgia were the most common symptoms of IgM-positive cases. Most patients did not report a tick bite.

Early-career researchers' views on ethical dimensions of patient engagement in research

Background

Increasing attention and efforts are being put towards engaging patients in health research, and some have even argued that patient engagement in research (PER) is an ethical imperative. Yet there is relatively little empirical data on ethical issues associated with PER.

Methods

A three-round Delphi survey was conducted with a panel of early-career researchers (ECRs) involved in PER. One of the objectives was to examine the ethical dimensions of PER as well as ECRs’ self-perceived level of preparedness to conduct PER ethically. The study was conducted among awardees of the Québec SPOR-SUPPORT Unit in Canada, who represent the next generation of researchers involved in PER. Many themes were addressed throughout the study, such as definition, values, patients’ roles, expected characteristics of patients, and anticipated challenges (including ethical issues). Open-ended questions were used, and all quantitative data were collected through statements using 7-point Likert scales.

Results

Between April and November 2016, 25 ECRs were invited to participate; 18 completed both the first and second rounds, and 16 completed the third round. Panelists consisted of nine women and seven men with various backgrounds (general practitioners and postgraduate students). The majority were between 25 and 44 years old. Panelists’ responses showed PER raises important ethical issues: 1) professionalization of patients involved in research (with risks of patients becoming less representative); 2) adequate remuneration of patients; 3) fair recognition of patients’ experiential knowledge; and 4) tokenism (engaging patients only for symbolic appeal). While the panelists felt moderately prepared to confront these ethical issues, they reported being uncomfortable applying for an ethics certificate for a PER project.

Conclusion

If PER is an ethical imperative, it is vital to establish clear ethical standards and to train and support the PER community to identify and resolve ethical issues. Despite their overall readiness to conduct PER, panelists did not feel adequately prepared to address many of these issues. It is not easy for ECRs to reconcile ethical desiderata and logistical imperatives. Additional research should focus on supporting the responsible conduct of PER, which, if not done, can undermine the credibility and feasibility of the entire PER enterprise.

Efficacy of a Web-Based Tailored Intervention to Reduce Cannabis Use Among Young People Attending Adult Education Centers in Quebec

BACKGROUND

Cannabis use is common among young adults. Web-based interventions are an increasingly popular way to reach this population. The aim of this study was to evaluate the efficacy of a Web-based tailored intervention, developed on theoretical and empirical grounds, to reduce cannabis use among young people by promoting a more positive intention to abstain.

METHODS

An experimental design was employed to evaluate the efficacy of the intervention in reducing cannabis use (primary outcome) by bolstering intention (secondary outcome) to abstain from use. Participants were randomly assigned either to an experimental group that received the Web-based tailored intervention or to a control group that did not.

RESULTS

Of 588 young adults (18-24 years of age) recruited, 295 were randomly assigned to the experimental group and 293 to the control group. At baseline, 343 reported using cannabis at least once in the past year. An intention-to-treat analysis showed that, at postintervention, a higher proportion of participants in the experimental group had reduced their cannabis use compared with the control group [10.8% vs. 5.1%, χ²(2) = 9.89, p = 0.007]. A mixed model for repeated measures revealed a statistically significant difference in terms of change in intention to abstain from cannabis use in the coming month [Group × Time interaction, F(1,474) = 8.03, p = 0.005]: intention increased for the experimental group (5.07 ± 2.07 to 5.45 ± 1.88; p < 0.001), but stayed stable for the control group (5.32 ± 2.03 to 5.36 ± 1.99; p = 0.779).

CONCLUSION

This study shows that the intervention can be efficacious in reducing cannabis use among young people attending adult education centers.

Effects of e-learning in a continuing education context on nursing care: a review of systematic qualitative, quantitative and mixed studies reviews (protocol)

INTRODUCTION

Continuing education (CE) is imperative to the future of professional nursing. The use of e-learning by registered nurses for CE is spreading. A review of systematic reviews will be conducted to develop a broad picture of the effects of e-learning in a CE context on nursing care.

METHODS AND ANALYSIS

Systematic qualitative, quantitative and mixed studies reviews published in English, French or Spanish from 1 January 2006 will be included. The outcomes of interest will be extracted and analysed inductively and deductively from the Nursing Care Performance Framework; some themes include nursing resources, nurses' practice environment, processes, professional satisfaction, and nursing sensitive outcomes. Three reviewers will independently screen first the title and abstract of the papers, and then the full texts in order to assess eligibility. Two teams of two reviewers will extract the selected reviews' characteristics and data. The results from various types of reviews will be integrated using a data-based convergent synthesis design. We will conduct a thematic synthesis and transform all quantitative and mixed data into qualitative data.

ETHICS AND DISSEMINATION

Ethics approval is not required for review of systematic reviews. We will summarise evidence concerning the negative, neutral and positive effects of various forms of e-learning on different aspects of nursing care. If we find gaps in the literature, we will highlight them and suggest ideas for further research. We will also focus on positive effects and present, if possible, the components and characteristics of e-learning interventions that were found to be successful. We will present this protocol and results in international conferences in nursing, medical, and health informatics domains. We will also submit the results of our work for peer-review publication in a journal indexed in the international bibliographic database of biomedical information.

A Web-Based Tailored Intervention to Support Illness Management in Patients With an Acute Coronary Syndrome: Pilot Study

BACKGROUND

Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, to foster participation in a cardiac rehabilitation (CR) program, and to optimize recovery. Web-based tailored interventions have the potential to provide individualized information and counseling to optimize patient's illness management after hospital discharge.

OBJECTIVE

We aimed to assess the feasibility and acceptability of a Web-based tailored intervention (TAVIE@COEUR) designed to improve illness management in patients hospitalized for an ACS. Illness management outcomes were operationalized by self-care, medication adherence, anxiety management, cardiac risk factors reduction, and enrollment in a CR program.

METHODS

This posttest pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary care unit of a tertiary cardiology center. TAVIE@COEUR comprises three Web-based sessions, with a duration ranging from 10 to 45 min and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to patients' responses to questions. TAVIE@COEUR includes 90 pages, 85 videos, and 47 PDF documents divided across session 1 (S1), session 2 (S2), and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking (S1), emotional control and problem-solving skills (S2), and social skills and interacting with health professionals (S3). Throughout the videos, a virtual nurse (providing the intervention virtually) guides the participants in the acquisition of self-care skills. Patients completed S1 of TAVIE@COEUR before hospital discharge and were asked to complete S2 and S3 within 2 weeks after discharge. Feasibility indicators were extracted from the TAVIE@COEUR system. Data regarding acceptability (satisfaction and appreciation of the platform) and preliminary effect (self-care, medication adherence, anxiety management, risk factor reduction, and CR enrollment) were assessed through questionnaires at 1 month following discharge. Preliminary effect was assessed by comparing baseline and 1-month illness management variables.

RESULTS

Of the 30 participants, 20 completed S1, 10 completed S2, and 5 completed S3. Good acceptability scores were observed for ease of navigation (mean=3.58, standard deviation [SD]=0.70; scale=0-4), ease of understanding (mean=3.46, SD=0.63; scale=0-4), and applicability (mean=3.55, SD=0.74; scale=0-4). The lowest acceptability scores were observed for information tailoring (mean=2.93, SD=0.68; scale=0-4) and individual relevance (mean=2.56, SD=0.96; scale=0-4). With regard to preliminary effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at 1 month=54.07, SD=3.99 vs mean at baseline=49.09, SD=6.92; scale-0-60).

CONCLUSIONS

Although participants reported general satisfaction and appreciation of TAVIE@COEUR, acceptability and feasibility results show the need for further development of the Web-based intervention to enhance its tailoring before undertaking a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to patients' knowledge, needs, interests, individual capabilities, and emotional and cognitive responses during session completion.

Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews

Background

Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care.

Objective

An overview of systematic reviews was conducted to develop a broad picture of the dimensions and indicators of nursing care that have the potential to be influenced by the use of ICTs.

Methods

Quantitative, mixed-method, and qualitative reviews that aimed to evaluate the influence of four eHealth domains (eg, management, computerized decision support systems [CDSSs], communication, and information systems) on nursing care were included. We used the nursing care performance framework (NCPF) as an extraction grid and analytical tool. This model illustrates how the interplay between nursing resources and the nursing services can produce changes in patient conditions. The primary outcomes included nurses’ practice environment, nursing processes, professional satisfaction, and nursing-sensitive outcomes. The secondary outcomes included satisfaction or dissatisfaction with ICTs according to nurses’ and patients’ perspectives. Reviews published in English, French, or Spanish from January 1, 1995 to January 15, 2015, were considered.

Results

A total of 5515 titles or abstracts were assessed for eligibility and full-text papers of 72 articles were retrieved for detailed evaluation. It was found that 22 reviews published between 2002 and 2015 met the eligibility criteria. Many nursing care themes (ie, indicators) were influenced by the use of ICTs, including time management; time spent on patient care; documentation time; information quality and access; quality of documentation; knowledge updating and utilization; nurse autonomy; intra and interprofessional collaboration; nurses’ competencies and skills; nurse-patient relationship; assessment, care planning, and evaluation; teaching of patients and families; communication and care coordination; perspectives of the quality of care provided; nurses and patients satisfaction or dissatisfaction with ICTs; patient comfort and quality of life related to care; empowerment; and functional status.

Conclusions

The findings led to the identification of 19 indicators related to nursing care that are impacted by the use of ICTs. To the best of our knowledge, this was the first attempt to apply NCPF in the ICTs’ context. This broad representation could be kept in mind when it will be the time to plan and to implement emerging ICTs in health care settings.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews: CRD42014014762; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014762 (Archived by WebCite at http://www.webcitation.org/6pIhMLBZh)

Effects of e-Learning and m-Learning on Nursing Care in a Continuing Education Context: An Overview of Mixed Method Systematic Reviews (Protocol)

Continuing education is an imperative for professional nursing. e-Learning is one modality to support education and it has been extensively examined in a nursing academic context. An overview of quantitative, qualitative, and mixed-method systematic reviews were conducted to draw a broad picture of the effects of e-Learning and m-Learning used by registered nurses in a continuing education context.

How Do Information and Communication Technologies Influence Nursing Care?

Despite the well-known advantages of information and communication technologies (ICTs), their overall impact on nursing care has not been synthesized. The objective of this overview of systematic reviews is to summarize the best evidence regarding the effects of ICTs on nursing care. We considered quantitative, qualitative and mixed-method reviews published since January 1995. Two reviewers independently screened the title and abstract of 5515 papers to assess their eligibility. From these, 72 full-text papers were evaluated and 28 publications met the inclusion criteria. Three reviewers extracted and compared their data. Preliminary results show that the following dimensions of nursing care are the most frequently reported: assessment, care planning and evaluation, documentation time, quality of care and patient safety. This overview provides a starting point from which to compare and contrast findings of separate reviews regarding the positive, neutral and negative effects of ICTs on nursing care.

VIH-TAVIE

The use of information and communication technologies for designing web-based nursing interventions is growing exponentially. Despite the interest devoted to such approaches, little is known about their foundational principles and the way they translate into virtual nursing practice to generate meaningful engagement with patients. VIH-TAVIE^TM is a virtual nursing intervention aiming to empower people living with HIV to help them in managing their antiretroviral therapy. Here we present VIH-TAVIE^TM relational model of engagement - its core components informed by interview data with patients and a virtual nurse: building a virtual presence founded on caring relational principles and values; creating a caring environment where patients feel safe, supported and respected; stimulating patients' engagement by offering supportive and tailored messages; transposing nursing communication skills into a virtual practice to build trust and reciprocal relationships. This study suggests that empowering connections can develop between a nurse and a patient within a caring virtual environment.

Virtual Nursing Intervention Adjunctive to Conventional Care: The Experience of Persons Living With HIV

Background

Persons living with HIV (PLHIV) must adhere optimally to antiretroviral therapy (ART) on a daily basis and for their lifetime to maintain an undetectable viral load, allowing them to preserve their health. Taking advantage of the opportunity that information and communication technologies provide to broaden intervention modalities and intensify clinical follow-up, a virtual nursing intervention consisting of four interactive computer sessions was developed to empower PLHIV to manage their ART and symptoms optimally. Compared with other types of information and communication technologies-assisted interventions such as text messages, HIV Treatment, Virtual Nursing Assistance and Education (VIH-TAVIE) requires a certain degree of active engagement on the part of the user to develop and strengthen the self-management skills to optimize adherence. After the intervention’s impact on ART adherence was measured quantitatively, a qualitative study was undertaken to describe how users experience the intervention. Understanding how PLHIV perceive being assisted asynchronously by a virtual nurse was of particular interest.

Objective

The objective of the study was to explore and describe how PLHIV experience VIH-TAVIE, that is, receiving customized asynchronous accompaniment via a virtual nurse.

Methods

A qualitative study was conducted with 26 PLHIV (20 men, 6 women) who received all four VIH-TAVIE sessions. Participants had been diagnosed with HIV 14 years earlier on average and had been on ART for a mean period of 10 years. The sessions lasted 20-30 minutes each and were received two weeks apart. They are hosted by a virtual nurse who engages the user in a self-management skills-learning process for the purpose of treatment adherence. Semistructured interviews were conducted lasting 30-40 minutes to get participants to share their experience of the intervention through personal stories and what they thought and felt during their participation. Data were analyzed using Miles and Huberman’s method, by performing these three steps: (1) data reduction (data coding, summaries); (2) data display (in tables and text form); and (3) recontextualization of results.

Results

Content analysis yielded five themes regarding how PLHIV experience VIH-TAVIE: (1) exposure to the virtual nursing intervention; (2) virtual nurse humanizes experience of the computer-delivered intervention; (3) learner’s experience of the virtual nursing intervention; (4) perceived benefits following participation in the virtual nursing intervention; and (5) relevance of the virtual nursing intervention in relation to the medication management trajectory.

Conclusions

Analyzing the participants’ experience revealed they found the intervention’s content and format appropriate. To them, the virtual nurse humanized the experience and helped them acquire new skills for achieving optimal ART adherence. Results seem to underscore the importance of offering the intervention to persons who have more problems with drug intake or who are just beginning ART.

Virtual intervention to support self-management of antiretroviral therapy among people living with HIV

Background

Living with human immunodeficiency virus (HIV) necessitates long-term health care follow-up, particularly with respect to antiretroviral therapy (ART) management. Taking advantage of the enormous possibilities afforded by information and communication technologies (ICT), we developed a virtual nursing intervention (VIH-TAVIE) intended to empower HIV patients to manage their ART and their symptoms optimally. ICT interventions hold great promise across the entire continuum of HIV patient care but further research is needed to properly evaluate their effectiveness.

Objective

The objective of the study was to compare the effectiveness of two types of follow-up—traditional and virtual—in terms of promoting ART adherence among HIV patients.

Methods

A quasi-experimental study was conducted. Participants were 179 HIV patients on ART for at least 6 months, of which 99 were recruited at a site offering virtual follow-up and 80 at another site offering only traditional follow-up. The primary outcome was medication adherence and the secondary outcomes were the following cognitive and affective variables: self-efficacy, attitude toward medication intake, symptom-related discomfort, stress, and social support. These were evaluated by self-administered questionnaire at baseline (T0), and 3 (T3) and 6 months (T6) later.

Results

On average, participants had been living with HIV for 14 years and had been on ART for 11 years. The groups were highly heterogeneous, differing on a number of sociodemographic dimensions: education, income, marital status, employment status, and living arrangements. Adherence at baseline was high, reaching 80% (59/74) in the traditional follow-up group and 84% (81/97) in the virtual follow-up group. A generalized estimating equations (GEE) analysis was run, controlling for sociodemographic characteristics at baseline. A time effect was detected indicating that both groups improved in adherence over time but did not differ in this regard. Improvement at 6 months was significantly greater than at 3 months in both groups. Analysis of variance revealed no significant group-by-time interaction effect on any of the secondary outcomes. A time effect was observed for the two kinds of follow-ups; both groups improved on symptom-related discomfort and social support.

Conclusions

Results showed that both interventions improved adherence to ART. Thus, the two kinds of follow-up can be used to promote treatment adherence among HIV patients on ART.

Psychosocial profile and lived experience of HIV-infected long-term nonprogressors: a mixed method study

The goal of this mixed method study was to describe the psychosocial profile of HIV-infected persons identified as long-term nonprogressors (LTNP), and their experiences of nonprogression. Data were collected from 24 participants with a mean age of 48 years and a mean duration of infection of 14 years. Results show rather moderate levels of anxiety and depression symptoms and a modest mean score of social support. Participants adapted by using acceptance, positive restructuring, and active coping strategies. Seven themes marked the experience: (a) reacting to announcement and dealing with diagnosis, (b) valuing interpersonal relations and well-being, (c) making changes in life, (d) coping with stress, (e) dealing with health care, (f) beliefs about reasons for nonprogression, and (g) living positively while dreading progression. The findings enrich a field of knowledge that has had little attention so far and shed light on the psychosocial profile of LTNP and their experiences of nonprogression.

Genetic analysis of the FUS/TLS gene in essential tremor

BACKGROUND AND PURPOSE

Although essential tremor (ET) has a genetic basis, specific genes have not been identified. Recently, in a large ET family (FET1) from Quebec, a non-sense mutation (p.Q290X) in the amyotrophic lateral sclerosis (ALS) gene fused in sarcoma/translated in liposarcoma (FUS/TLS) was identified by exome sequencing. No confirmatory studies have been published.

METHODS

Two-hundred and fifty-nine ET cases and 262 controls were enrolled in a study at Columbia University. We performed a comprehensive analysis of the FUS/TLS gene by sequencing all exons in a subsample of 116 ET cases with early-onset (≤40 years) ET. We evaluated an association between ET and SNPs in the FUS/TLS gene by genotyping four haplotype tagging SNPs in all 259 ET cases and 262 controls. Additionally, seven variants associated with ALS, two variants of unknown pathogenicity detected in ALS cases, eight mis-sense variants predicted to be damaging, and six rare variants were genotyped in these 259 ET cases and 262 controls.

RESULTS

FUS/TLS mutations previously reported in ALS, the FET1 family, or novel mutations were not found in any of the 116 early-onset ET cases. In the case-control analyses, although the power of the performed associations was limited, no significant association between tagging SNPs in FUS/TLS and ET was observed, and none of the analyzed SNPs showed evidence of association with ET.

CONCLUSION

Our study suggests that pathogenic mutations in FUS/TLS are rare in a sample of early-onset ET cases in North America. We did not find evidence that the FUS/TLS gene is a risk factor for ET.

Disclosure experience in a convenience sample of Quebec-born women living with HIV: a phenomenological study

BACKGROUND

In Canada, there has been a considerable increase in the number of women infected with the human immunodeficiency virus (HIV). Within a stigmatized social context, disclosure of HIV positivity is still a prevailing concern among women. Little is known about the global understanding of how French-speaking, Quebec-born women living with HIV, live their serostatus disclosure experience. The aim of this qualitative study is to describe and understand the disclosure experience of these women.

METHODS

We conducted semi-structured interviews with seven women. A convenience sample of French-speaking, Quebec-born women was chosen because they all responded to the criteria of wishing to share their disclosure experience. The mean age of the participants was 46 years old (SD±12). They lived with HIV for an average of 10 years; time since diagnosis varied from 8 months to 23 years. Two out of four mothers had given birth to HIV positive children. Data analysis proposed by van Manen was performed to discover the essential themes of the experience.

RESULTS

Seven themes were identified to understand the experience of disclosure in women: 1) Respecting for self and confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of disclosure/non-disclosure; 5) Exposing oneself to stigma and social exclusion; 6) Suffering internally; and 7) Benefitting from the positive effects of one's decision. For these women, disclosing their HIV status meant: Living the ambivalence of a paradoxical process of revealing/concealing, in a state of profound suffering, exacerbated by stigma, while also being enriched by the benefits attained.

CONCLUSIONS

Understanding the experience of disclosure in WLHIV is important to guide actions in the practice to support and accompany these women in their unique reality. Health professionals have to broaden their role and work on individual, interpersonal, inter-organizational and intersectoral levels. Mobilization of actors from different sectors would facilitate the implementation of pertinent and opportune interventions.

Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial

BACKGROUND

Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I'immunodéficience Humaine-Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV.

METHODS/DESIGN

A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context.

DISCUSSION

Carrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services.

TRIAL REGISTRATION

CE 11.184 / NCT 01510340.

Acceptability and feasibility of a virtual intervention to help people living with HIV manage their daily therapies

We conducted a study of the acceptability and feasibility of a web application which was designed to empower people living with HIV to manage their daily antiretroviral therapies. The application (VIH-TAVIE) consists of four interactive computer sessions with a virtual nurse who guides the user through a learning process aimed at enhancing treatment management capacities. The information furnished and the strategies proposed by the nurse are tailored, based on the responses provided by the user. The application was evaluated in a hospital setting as an adjunct to usual care. The participants (n = 71) had a mean age of 47 years (SD = 7.6). There were 59 men and 12 women. They had been diagnosed with HIV some 15 years earlier and had been on antiretroviral medication for a mean duration of 11 years. Data were collected by acceptability questionnaires, field notes and observations. Most participants found the application easy to use. They learned tips for taking their medication, diminishing adverse side-effects and maintaining a positive attitude towards treatment. Many participants deemed their experience with the application highly satisfactory and felt that it met their needs with respect to strategies and proficiencies despite their long experience of medication use. The results of the study support the feasibility and acceptability of the intervention.