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Berardi V, Phillips CB, McEntee ML, Stecher C, Todd M, Adams MA. The Impact of Monetary Incentives on Delay Discounting Within a Year-Long Physical Activity Intervention. Ann Behav Med 2024; 58:341-352. [PMID: 38507617 PMCID: PMC11008587 DOI: 10.1093/abm/kaae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Delay discounting is the depreciation in a reward's perceived value as a function of the time until receipt. Monetary incentive programs that provide rewards contingent on meeting daily physical activity (PA) goals may change participants' delay discounting preferences. PURPOSE Determine if monetary incentives provided in close temporal proximity to meeting PA goals changed delay discounting, and if such changes mediated intervention effects. METHODS Inactive adults (n = 512) wore accelerometers during a 12-month intervention where they received proximal monetary incentives for meeting daily moderate-to-vigorous PA (MVPA) goals or delayed incentives for study participation. Delay discount rate and average MVPA were assessed at baseline, end of intervention, and a 24-month follow-up. Using structural equation modeling, we tested effects of proximal versus delayed rewards on delay discounting and whether any changes mediated intervention effects on MVPA. PA self-efficacy was also evaluated as a potential mediator, and both self-efficacy and delay discounting were assessed as potential moderators of intervention effects. RESULTS Proximal rewards significantly increased participants' delay discounting (β = 0.238, confidence interval [CI]: -0.078, 0.380), indicating greater sensitivity to reinforcement timing. This change did not mediate incentive-associated increases in MVPA at the end of the 12-month intervention (β = -0.016, CI: -0.053, 0.019) or at a 24-month follow-up (β = -0.020, CI: -0.059, 0.018). Moderation effects were not found. CONCLUSIONS Incentive-induced increases in delay discounting did not deleteriously impact MVPA. This finding may help assuage concerns about using monetary incentives for PA promotion, but further research regarding the consequences of changes in delay discounting is warranted.
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Affiliation(s)
- Vincent Berardi
- Department of Psychology, Chapman University, Orange, CA, USA
| | | | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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McEntee ML, Hurley JC, Phillips CB, Hooker SP, Todd M, Frank LD, Adams MA. The moderating impact of neighborhood walkability on mHealth interventions to increase moderate to vigorous physical activity for insufficiently active adults in a randomized trial. Int J Behav Nutr Phys Act 2023; 20:97. [PMID: 37582736 PMCID: PMC10428579 DOI: 10.1186/s12966-023-01494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/23/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Ecological models suggest that interventions targeting specific behaviors are most effective when supported by the environment. This study prospectively examined the interactions between neighborhood walkability and an mHealth intervention in a large-scale, adequately powered trial to increase moderate-to-vigorous physical activity (MVPA). METHODS Healthy, insufficiently active adults (N = 512) were recruited purposefully from census block groups ranked on walkability (high/low) and socioeconomic status (SES, high/low). Participants were block-randomized in groups of four to WalkIT Arizona, a 12-month, 2 × 2 factorial trial evaluating adaptive versus static goal setting and immediate versus delayed financial reinforcement delivered via text messages. Participants wore ActiGraph GT9X accelerometers daily for one year. After recruitment, a walkability index was calculated uniquely for every participant using a 500-m street network buffer. Generalized linear mixed-effects hurdle models tested for interactions between walkability, intervention components, and phase (baseline vs. intervention) on: (1) likelihood of any (versus no) MVPA and (2) daily MVPA minutes, after adjusting for accelerometer wear time, neighborhood SES, and calendar month. Neighborhood walkability was probed at 5th, 25th, 50th, 75th, and 95th percentiles to explore the full range of effects. RESULTS Adaptive goal setting was more effective in increasing the likelihood of any MVPA and daily MVPA minutes, especially in lower walkable neighborhoods, while the magnitude of intervention effect declined as walkability increased. Immediate reinforcement showed a greater increase in any and daily MVPA compared to delayed reinforcement, especially relatively greater in higher walkable neighborhoods. CONCLUSIONS Results partially supported the synergy hypotheses between neighborhood walkability and PA interventions and suggest the potential of tailoring interventions to individuals' neighborhood characteristics. TRIAL REGISTRATION Preregistered at clinicaltrials.gov (NCT02717663).
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Affiliation(s)
- Mindy L McEntee
- College of Health Solutions, Arizona State University, 425 North 5th Street, MC9020, Phoenix, AZ, 85004, USA
| | - Jane C Hurley
- College of Health Solutions, Arizona State University, 425 North 5th Street, MC9020, Phoenix, AZ, 85004, USA
| | | | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA, USA
| | - Michael Todd
- College of Nursing and Health Innovations, Arizona State University, Phoenix, AZ, USA
| | - Lawrence D Frank
- Department of Urban Studies and Planning, University of California San Diego, San Diego, CA, USA
| | - Marc A Adams
- College of Health Solutions, Arizona State University, 425 North 5th Street, MC9020, Phoenix, AZ, 85004, USA.
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Rose GL, Weldon TL, McEntee ML, Hitt JR, Kessler R, Littenberg B, Macchi CR, Martin MP, Mullin DJ, van Eeghen C. Practice integration profile revised: Improving item readability and completion. Fam Syst Health 2023; 41:201-206. [PMID: 36048050 DOI: 10.1037/fsh0000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The Practice Integration Profile (PIP) is a reliable, valid, and broadly used measure of the integration of behavioral health (BH) into primary care. The PIP assesses operational and procedural elements that are grounded in the AHRQ Lexicon for Behavioral Health and Primary Care Integration. Prior analyses of PIP data and feedback from users suggested the measure was in need of revisions. This article describes the process used to improve readability, clarity, and pragmatic utility of the instrument. METHOD Two rounds of structured cognitive interviews were conducted with clinicians in primary care settings. After each round, interview transcripts were coded by an analytic team using an iterative and consensus-driven process. Themes were identified based on codes. Themes and recommendations for revisions were reviewed and modified by committee. RESULTS Based on feedback and a prior factor analysis of the PIP, revisions were undertaken to: (a) eliminate redundant or overlapping items; (b) clarify the meaning of items; (c) standardize the response categories, and (d) place items in the most appropriate domains. The resulting measure has 28 items in five domains. DISCUSSION PIP 2.0 will need further examination to confirm its continuing use as a foundational tool for evaluating integrated care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Gail L Rose
- Larner College of Medicine, University of Vermont
| | - Tara L Weldon
- College of Health Solutions, Arizona State University
| | | | | | | | | | - C R Macchi
- College of Health Solutions, Arizona State University
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McEntee ML, Philip SR, Phelan SM. Dismantling weight stigma in eating disorder treatment: Next steps for the field. Front Psychiatry 2023; 14:1157594. [PMID: 37113547 PMCID: PMC10126256 DOI: 10.3389/fpsyt.2023.1157594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
The authors posit current guidelines and treatment for eating disorders (EDs) fail to adequately address, and often perpetuate, weight stigma. The social devaluation and denigration of higher-weight individuals cuts across nearly every life domain and is associated with negative physiological and psychosocial outcomes, mirroring the harms attributed to weight itself. Maintaining focus on weight in ED treatment can intensify weight stigma among patients and providers, leading to increased internalization, shame, and poorer health outcomes. Stigma has been recognized as a fundamental cause of health inequities. With no clear evidence that the proposed mechanisms of ED treatment effectively address internalized weight bias and its association with disordered eating behavior, it is not hard to imagine that providers' perpetuation of weight bias, however unintentional, may be a key contributor to the suboptimal response to ED treatment. Several reported examples of weight stigma in ED treatment are discussed to illustrate the pervasiveness and insidiousness of this problem. The authors contend weight management inherently perpetuates weight stigma and outline steps for researchers and providers to promote weight-inclusive care (targeting health behavior change rather than weight itself) as an alternative approach capable of addressing some of the many social injustices in the history of this field.
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Affiliation(s)
- Mindy L. McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
- *Correspondence: Mindy L. McEntee,
| | - Samantha R. Philip
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Sean M. Phelan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Martin MP, McEntee ML, Mullin D, Suri Y, van Eeghen C. Patient screening for integrated behavioral health in adult primary care: A rapid review of effective procedures. Fam Syst Health 2022; 40:383-396. [PMID: 35653737 DOI: 10.1037/fsh0000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Although many primary care clinics screen for behavioral health (BH) conditions using validated tools, it is not clear whether adult BH screening leads to better patient outcomes. Our objective was to determine the evidence base by reviewing effectiveness research for multiple strategies of BH screening in adult primary care identified in the Practice Integration Profile. METHOD We conducted five rapid reviews of effectiveness research supporting BH screening strategies cited in the Practice Integration Profile. Each rapid review was conducted using an adapted REAL (Rapid Evidence Assessment of the Literature) methodology and a standardized search tailored for each screening strategy to identify evidence related to BH screening in primary care. RESULTS The database search yielded 931 references. Following eligibility review and extraction, we evaluated data from 20 references examining five screening strategies. Results demonstrated limited support for all five strategies and high risk of bias within most studies. Outcomes associated with various BH screening strategies were rarely the focus of study. CONCLUSIONS There is an absence of robust, well-structured evidence supporting many of the BH screening strategies advocated for in primary care. Stakeholders may wish to understand how to ensure value when developing a robust screening program that will improve patient health outcomes. Future research should advance the science of BH screen selection, timing, and implementation by answering new questions about screening strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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McEntee ML, Gandek B, Ware JE. Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index. Health Qual Life Outcomes 2022; 20:108. [PMID: 35820890 PMCID: PMC9277868 DOI: 10.1186/s12955-022-02016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Interpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes.
Methods Online surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R2) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up.
Results In comparison with sociodemographic-only regression models (MCS R2 = 0.08, PCS = 0.09) and Charlson CCI models (MCS R2 = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R2 = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R2 = 0.31–0.38, respectively) and individualized QDIS weighting (R2 = 0.33 & 0.42). Model R2 and fit were replicated upon cross-validation. Conclusions Physical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02016-7.
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Affiliation(s)
- Mindy L McEntee
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA.
| | - Barbara Gandek
- University of Massachusetts Medical School, Worchester, MA, USA.,John Ware Research Group, Inc., Watertown, MA, USA
| | - John E Ware
- College of Health Solutions, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004-0698, USA.,University of Massachusetts Medical School, Worchester, MA, USA.,John Ware Research Group, Inc., Watertown, MA, USA
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Adams MA, Todd M, Angadi SS, Hurley JC, Stecher C, Berardi V, Phillips CB, McEntee ML, Hovell MF, Hooker SP. Adaptive Goals and Reinforcement Timing to Increase Physical Activity in Adults: A Factorial Randomized Trial. Am J Prev Med 2022; 62:e57-e68. [PMID: 35000693 PMCID: PMC8820277 DOI: 10.1016/j.amepre.2021.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/24/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Potent lifestyle interventions to increase moderate-to-vigorous physical activity are urgently needed for population-level chronic disease prevention. This trial tested the independent and joint effects of a mobile health system automating adaptive goal setting and immediate financial reinforcement for increasing daily walking among insufficiently active adults. STUDY DESIGN Participants were randomized into a 2 (adaptive versus static goal setting) X 2 (immediate versus delayed financial incentive timing) condition factorial trial to increase walking. SETTINGS/PARTICIPANTS Participants (N=512 adults) were recruited between 2016 and 2018 and were 64.5% female, aged 18-60 years, 18.8% Hispanic, 6.1% African American, and 83% White. INTERVENTION Principles of reinforcement and behavioral economics directed intervention design. MAIN OUTCOME MEASURES Participants wore accelerometers daily (133,876 day-level observations) that remotely measured moderate-to-vigorous physical activity bout minutes of ≥3 minutes/day for 1 year. Primary outcomes were between-condition differences in (1) engaging ≥1 bout of moderate-to-vigorous physical activity on each day and (2) on days with ≥1 bout, daily total moderate-to-vigorous physical activity minutes. RESULTS Mixed-effects hurdle models tested treatment group X phase (time) interactions using an intent-to-treat approach in 2021. Engaging in any ambulatory moderate-to-vigorous physical activity was greater for Adaptive than for Static Goal groups (OR=2.34, 95% CI=2.10, 2.60 vs OR=1.66, 95% CI=1.50, 1.84; p<0.001) and for Immediate than for Static Reinforcement groups (OR=2.16 95% CI=1.94, 2.40 vs OR=1.77, 95% CI=1.59, 1.97; p<0.01). The Immediate Reinforcement group increased by 16.54 moderate-to-vigorous physical activity minutes/day, whereas the Delayed Reinforcement group increased by 9.91 minutes/day (p<0.001). The combined Adaptive Goals + Immediate Reinforcement group increased by 16.52 moderate-to-vigorous physical activity minutes/day, significantly more than that of either Delayed Reinforcement group. CONCLUSIONS This study offers automated and scalable-behavior change strategies for increasing walking among adults most at-risk for chronic diseases attributed to sedentary lifestyles. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02717663).
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Affiliation(s)
- Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Siddhartha S Angadi
- College of Health Solutions, Arizona State University, Phoenix, Arizona; Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, Virginia
| | - Jane C Hurley
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Vincent Berardi
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, California
| | | | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Melbourne F Hovell
- School of Public Health, San Diego State University, San Diego, California
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California
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Sung K, Glazer H, O'Grady J, McEntee ML, Bosley L, Reich DB, Gordon B. Measuring visual electrophysiological responses in individuals with low-functioning autism: a feasibility and pilot study. Pilot Feasibility Stud 2022; 8:7. [PMID: 35031056 PMCID: PMC8759181 DOI: 10.1186/s40814-021-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Although visual abnormalities are considered common in individuals with autism spectrum disorders, the associated electrophysiological markers have remained elusive. One impediment has been that methodological challenges often preclude testing individuals with low-functioning autism (LFA). Methods In this feasibility and pilot study, we tested a hybrid visual evoked potential paradigm tailored to individuals with LFA that combines passively presented visual stimuli to elicit scalp-recorded evoked responses with a behavioral paradigm to maintain visual attention. We conducted a pilot study to explore differences in visual evoked response patterns across three groups: individuals with LFA, with high-functioning autism (HFA), and with typical development. Results All participants with LFA met criteria for study feasibility by completing the recordings and producing measurable cortical evoked waveform responses. The LFA group had longer (delayed) cortical response latencies on average as compared with the HFA and typical development groups. We also observed group differences in visually induced alpha spectral power: the LFA group showed little to no prestimulus alpha activity in contrast to the HFA and typical development groups that showed increased prestimulus alpha activity. This observation was confirmed by the bootstrapped confidence intervals, suggesting that the absence of prestimulus alpha power may be a potential electrophysiological marker of LFA. Conclusion Our results confirm the utility of tailoring visual electrophysiology paradigms to individuals with LFA in order to facilitate inclusion of individuals across the autism spectrum in studies of visual processing. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00960-7.
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Affiliation(s)
- Kyongje Sung
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA.,Counseling, Special Education, and Neuroscience Division, Emirates College for Advanced Education, Abu Dhabi, United Arab Emirates
| | - Hanna Glazer
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA
| | - Jessica O'Grady
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA
| | - Mindy L McEntee
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA.,College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Laura Bosley
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA
| | - Dana Boatman Reich
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA.
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA.,Cognitive Science Department, Johns Hopkins University, Baltimore, Maryland, USA
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Johnson SS, Sowa M, McCann R, Cohen SA, Nash CC, Greaney ML, Alexander RA, Kasten J, Martin MP, McEntee ML, Suri Y, Roman C, Bane S, Opthof E. Knowing Well, Being Well: well-being born of understanding: The Science of Teamwork. Am J Health Promot 2021; 35:1028-1047. [PMID: 34351249 DOI: 10.1177/08901171211030142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Martin MP, McEntee ML, Suri Y. Caregiver Quality of Life: How to Measure It and Why. Am J Health Promot 2021; 35:1042-1045. [PMID: 34351244 DOI: 10.1177/08901171211030142f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Yash Suri
- Arizona State University, Phoenix, AZ, USA
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11
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McEntee ML, Cantley A, Foreman E, Berardi V, Phillips CB, Hurley JC, Hovell MF, Hooker S, Adams MA. Effects of Goal Type and Reinforcement Type on Self-Reported Domain-Specific Walking Among Inactive Adults: 2×2 Factorial Randomized Controlled Trial. JMIR Form Res 2020; 4:e19863. [PMID: 33275107 PMCID: PMC7748953 DOI: 10.2196/19863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/29/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background WalkIT Arizona was a 2×2 factorial trial examining the effects of goal type (adaptive versus static) and reinforcement type (immediate versus delayed) to increase moderate to vigorous physical activity (MVPA) among insufficiently active adults. The 12-month intervention combined mobile health (mHealth) technology with behavioral strategies to test scalable population-health approaches to increasing MVPA. Self-reported physical activity provided domain-specific information to help contextualize the intervention effects. Objective The aim of this study was to report on the secondary outcomes of self-reported walking for transportation and leisure over the course of the 12-month WalkIT intervention. Methods A total of 512 participants aged 19 to 60 years (n=330 [64.5%] women; n=425 [83%] Caucasian/white, n=96 [18.8%] Hispanic/Latinx) were randomized into interventions based on type of goals and reinforcements. The International Physical Activity Questionnaire-long form assessed walking for transportation and leisure at baseline, and at 6 months and 12 months of the intervention. Negative binomial hurdle models were used to examine the effects of goal and reinforcement type on (1) odds of reporting any (versus no) walking/week and (2) total reported minutes of walking/week, adjusted for neighborhood walkability and socioeconomic status. Separate analyses were conducted for transportation and leisure walking, using complete cases and multiple imputation. Results All intervention groups reported increased walking at 12 months relative to baseline. Effects of the intervention differed by domain: a significant three-way goal by reinforcement by time interaction was observed for total minutes of leisure walking/week, whereas time was the only significant factor that contributed to transportation walking. A sensitivity analysis indicated minimal differences between complete case analysis and multiple imputation. Conclusions This study is the first to report differential effects of adaptive versus static goals for self-reported walking by domain. Results support the premise that individual-level PA interventions are domain- and context-specific and may be helpful in guiding further intervention refinement. Trial Registration Preregistered at clinicaltrials.gov: (NCT02717663) https://clinicaltrials.gov/ct2/show/NCT02717663 International Registered Report Identifier (IRRID) RR2-10.1016/j.cct.2019.05.001
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Affiliation(s)
- Mindy L McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Alison Cantley
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Emily Foreman
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Vincent Berardi
- Department of Psychology, Crean School of Health and Behavioral Sciences, Chapman University, Orange, CA, United States
| | | | - Jane C Hurley
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Melbourne F Hovell
- College of Health and Human Services, San Diego State University, San Diego, CA, United States
| | - Steven Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA, United States
| | - Marc A Adams
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Vowles KE, Pielech M, Edwards KA, McEntee ML, Bailey RW. A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain. J Pain 2019; 21:529-545. [PMID: 31683020 DOI: 10.1016/j.jpain.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/07/2019] [Accepted: 10/27/2019] [Indexed: 11/17/2022]
Abstract
While much of the literature provides positive support for psychological interventions for chronic pain, 2 recent meta-analyses indicate small to moderate benefits only. This inconsistency in findings suggests that there are other treatment-related variables to consider. One possible consideration pertains to treatment format, as psychological models form the basis for both unidisciplinary psychology and integrated interdisciplinary treatments for chronic pain. Therefore, a comparative meta-analysis of unidisciplinary and interdisciplinary treatments was performed to determine whether there were differences in treatment effect size (ES) at post-treatment and follow-ups of up to 1 year. One specific treatment model, Acceptance and Commitment Therapy (ACT), was investigated as it was felt that this literature was extensive enough to perform the planned analysis, while also being circumscribed enough in size to make it feasible. In total, 29 articles met inclusion criteria, 13 reported outcomes for unidisciplinary ACT, and 15 for interdisciplinary ACT. At both post-treatment and follow-up, interdisciplinary ACT had a greater ES for physical disability, psychosocial impact, and depression compared to unidisciplinary ACT. No differences in ES were observed for pain intensity, pain-related anxiety, or pain acceptance. Findings remained the same when study heterogeneity was considered. There was a significant difference observed between treatment format and treatment duration-on average, unidisciplinary interventions were of shorter duration than interdisciplinary interventions. Moderation analyses examining the relation between total treatment duration and ES generally indicated a moderate positive relation between treatment length and ES. This relation was strong for psychosocial impact. PERSPECTIVE: A comparative meta-analysis examined the relative ES of unidisciplinary (ie, clinical psychology only) and interdisciplinary ACT for chronic pain in 29 studies. The ES for interdisciplinary ACT was larger than unidisciplinary ACT for physical disability, psychosocial impact, and depression. No differences were present for pain intensity, anxiety, and acceptance.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Melissa Pielech
- Center for Alcohol and Addictions Studies, Brown University, Providence, Rhode Island
| | - Karlyn A Edwards
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Mindy L McEntee
- College of Health Solutions, Arizona State University, Tempe, Arizona
| | - Robert W Bailey
- Swedish Pain Services, Swedish Health System, Seattle, Washington
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Vowles KE, Witkiewitz K, Pielech M, Edwards KA, McEntee ML, Bailey RW, Bolling L, Sullivan MD. Alcohol and Opioid Use in Chronic Pain: A Cross-Sectional Examination of Differences in Functioning Based on Misuse Status. J Pain 2018; 19:1181-1188. [PMID: 29758355 DOI: 10.1016/j.jpain.2018.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/16/2018] [Accepted: 04/29/2018] [Indexed: 12/11/2022]
Abstract
Opioid misuse is regularly associated with disrupted functioning in those with chronic pain. Less work has examined whether alcohol misuse may also interfere with functioning. This study examined frequency of opioid and alcohol misuse in 131 individuals (61.1% female) prescribed opioids for the treatment of chronic pain. Participants completed an anonymous survey online, consisting of measures of pain, functioning, and opioid and alcohol misuse. Cut scores were used to categorize individuals according to substance misuse status. Individuals were categorized as follows: 35.9% (n = 47) were not misusing either opioids or alcohol, 22.9% (n = 30) were misusing both opioids and alcohol, 38.2% (n = 50) were misusing opioids alone, and only 3.0% (n = 4) were misusing alcohol alone. A multivariate analysis of variance was performed to examine differences in pain and functioning between groups (after excluding individuals in the alcohol misuse group due to the small sample size). Group comparisons indicated that individuals who were not misusing either substance were less disabled and distressed in comparison to those who were misusing opioids alone or both opioids and alcohol. No differences were indicated between the latter 2 groups. Overall, the observed frequency of opioid misuse was somewhat higher in comparison to previous work (approximately 1 out of every 3 participants), and misuse of both alcohol and opioids was common (approximately 1 out of every 5 participants). While these data are preliminary, they do suggest that issues of substance misuse in those with chronic pain extends beyond opioids alone. PERSPECTIVE Opioid and alcohol misuse was examined in 131 individuals prescribed opioids for chronic pain. In total, 35.9% were not misusing either, 22.9% were misusing both, 38.2% were misusing opioids, and 3.1% were misusing alcohol. Individuals not misusing either were generally less disabled and distressed compared to those misusing opioids or both.
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Affiliation(s)
- Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Melissa Pielech
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Karlyn A Edwards
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Mindy L McEntee
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Robert W Bailey
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Lena Bolling
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Mark D Sullivan
- University of Washington, Departments of Psychiatry and Behavioral Sciences, Seattle, Washington
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McEntee ML, Vowles KE, McCracken LM. Development of a chronic pain–specific version of the Sickness Impact Profile. Health Psychol 2016; 35:228-237. [DOI: 10.1037/hea0000257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pielech M, Bailey RW, McEntee ML, Ashworth J, Levell J, Sowden G, Vowles KE. Preliminary Evaluation of the Values Tracker: A Two-Item Measure of Engagement in Valued Activities in Those With Chronic Pain. Behav Modif 2015; 40:239-56. [PMID: 26611467 DOI: 10.1177/0145445515616911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Engagement in valued activities is an important outcome, particularly in treatments that aim to enhance quality of life in those with chronic conditions. The present study describes the initial evaluation of the Values Tracker (VT), a two-item measure of values engagement, in 302 treatment-seeking adults with chronic pain. Hierarchical regression analyses were conducted to examine the utility of the VT in the statistical prediction of pain-related functioning, after controlling for demographic variables, pain intensity, and pain-related distress. Across analyses, pain intensity accounted for significant variance (range ΔR2 = .06-.09) with pain-related distress adding additional unique variance (range ΔR2 = .07-.19). The VT accounted for additional unique variance (range ΔR2 = .02-.17) for all variables with the exception of physical disability. These findings provide initial support for the utility of the VT in those with chronic pain. Given the VT's brevity, it may be particularly useful for tracking changes in engagement in values across sessions.
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Affiliation(s)
| | | | | | - Julie Ashworth
- Staffordshire and Stoke on Trent Partnership NHS Trust, UK
| | - Jayne Levell
- Staffordshire and Stoke on Trent Partnership NHS Trust, UK
| | - Gail Sowden
- Staffordshire and Stoke on Trent Partnership NHS Trust, UK
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