"Activity Matters was great - I now realize: if I move, I'm fitter.": development and process evaluation of a web-based program for persons with multiple sclerosis

PURPOSE

Research shows that persons with mild to moderate multiple sclerosis are less physically active than healthy controls even though they would benefit from it. This study focusses on the feasibility testing and process evaluation of the pilot study of Activity Matters, a twelve-week web-based program, from Ireland, to increase physical activity in this population.

MATERIALS AND METHODS

The intervention was adapted to local circumstances in Hamburg, Germany and consists of eleven modules incorporating behavior change techniques. After feasibility had been confirmed, 43 persons with multiple sclerosis participated in a pilot study with a pre-post, single-group intervention design. Qualitative data was collected with questionnaires and semi structured interviews. Physical activity level and stage of change was measured quantitatively.

RESULTS

Participants had a mean age of 49.5 years (SD 9.29) and an average Patient Determined Disease Step Score of 2.2 (SD 1.47). Thirty-six participants answered the follow-up questionnaire. On average 9.8 modules were processed within 13 weeks. Each tool for behavior change was perceived as helpful except the chat group. Physical activity levels increased significantly from pre- to post intervention (p-value 0.042, Cohen's d = 0.35).

CONCLUSIONS

The results indicate that Activity Matters is feasible and satisfactory and may change activity levels.

A novel socially assistive robotic platform for cognitive-motor exercises for individuals with Parkinson's Disease: a participatory-design study from conception to feasibility testing with end users

The potential of socially assistive robots (SAR) to assist in rehabilitation has been demonstrated in contexts such as stroke and cardiac rehabilitation. Our objective was to design and test a platform that addresses specific cognitive-motor training needs of individuals with Parkinson's disease (IwPD). We used the participatory design approach, and collected input from a total of 62 stakeholders (IwPD, their family members and clinicians) in interviews, brainstorming sessions and in-lab feasibility testing of the resulting prototypes. The platform we developed includes two custom-made mobile desktop robots, which engage users in concurrent cognitive and motor tasks. IwPD (n = 16) reported high levels of enjoyment when using the platform (median = 5/5) and willingness to use the platform in the long term (median = 4.5/5). We report the specifics of the hardware and software design as well as the detailed input from the stakeholders.

'That would have been the perfect thing after diagnosis': development of a digital lifestyle management application in multiple sclerosis

Background

A multiple sclerosis (MS) diagnosis urges decision-making on immunotherapies, while persons with MS (PwMS) need to develop a coping concept in parallel. At this stage, PwMS ask how they themselves may contribute to controlling the disease. Evidence suggests that maintaining a healthy lifestyle (e.g. physical activity and stress management) is a key factor for healthy aging and preserving activity, while data on MS are complex.

Objectives

Following the Medical Research Council framework, this study aimed to develop and investigate the feasibility of a new digital health application that conveys evidence-based patient information about lifestyle factors in MS and engages PwMS in relevant behaviour change techniques.

Methods

Based on a digital health application promoting lifestyle management in breast cancer survivors, an MS-specific adaptation ('levidex') was developed. Feasibility was tested with 15 PwMS and eight MS experts. Subsequently, a six-week pilot study with eight PwMS was conducted. All participants provided feedback on practicability and acceptability via a questionnaire and took part in a semi-structured telephone interview. Levidex was revised after each test phase.

Results

The final levidex tool includes 16 modules, 177 references and several other functions. Feasibility results showed that PwMS and MS experts perceived levidex as understandable (14 out of 15; 6 out of 8), trustworthy (15 out of 15; 8 out of 8), and relevant (10 out of 15; 8 out of 8). Interviews revealed potential for improvement regarding the length and complexity of some content. Piloting of the revised version confirmed good feasibility and high acceptance. Most participants felt inspired to initiate (7 out of 8) or had already implemented (5 out of 8) lifestyle changes after working with levidex.

Conclusion

Results suggest that levidex is feasible and well-accepted by PwMS and MS experts. It might be a useful tool to support PwMS in adapting to their diagnosis and initiating health-promoting lifestyle changes.

Internet-based support for informal caregivers to individuals with head and neck cancer (Carer eSupport): a study protocol for the development and feasibility testing of a complex online intervention

INTRODUCTION

It is strongly recommended that randomised controlled trials are preceded with an exploration of the needs of the target population and feasibility testing of the intervention. The present study protocol is set out to describe these steps in the development of a complex intervention.The past decades' transition of care from inpatient to outpatient settings has increased the complexity of caregivers' responsibilities, which they may not be prepared for. There is a need to support informal caregivers (ICs) to prepare them for caregiving and decrease the caregiver burden. The main aim of this study is to describe the development of an internet-based intervention (Carer eSupport) to improve ICs' ability to support individuals with head and neck cancer and to describe the testing of the feasibility and acceptability of Carer eSupport.

METHODS AND ANALYSIS

This is a multicentre study involving the ear, nose and throat clinics and the oncology and radiotherapy clinics at three university hospitals. The study protocol comprises two phases, development and feasibility testing, using the Medical Research Council framework for developing a complex intervention. Carer eSupport will be based on the results from focus group discussions with ICs and healthcare professionals (planned for n=6-8 in respective groups) and scientific evidence, the Social Cognitive Theory and the Theory of Acceptance and Use of Technology. The feasibility testing will include 30 ICs who will have access to Carer eSupport for 1 month. The feasibility testing will be evaluated with a mixed-method design.

ETHICS AND DISSEMINATION

All procedures have been approved by the Ethics Committee at Uppsala University (Dnr: 2020-04650). Informed consent will be obtained before enrolment of patients, their ICs and healthcare staff. The feasibility testing is registered at Clinicaltrials.gov (Identifier: NCT05028452). Findings will be disseminated in peer-reviewed journal publications.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov (Identifier: NCT05028452).

Promoting health equity in the health-care system: How can we identify potentially vulnerable patients?

BACKGROUND

There is documented social inequality in cancer. The health-care system may contribute to health equity by targeting interventions to potentially vulnerable patients who may be at risk of not receiving optimal treatment and care.

AIM

This study aimed to develop and pilot test a tool to identify patients who may need additional support.

METHOD

The study took place in a department of palliative medicine and in a team for head and neck cancer within an oncology department. The tool to identify potentially vulnerable patients was developed based on literature reviews and interviews with patients and health-care personnel. It was pilot tested in a six-month period, with subsequent interviews with health-care personnel.

RESULTS

In total, 212 consecutive patients referred to the departments were systematically screened with the tool by health-care personnel. Of these, 74 (35%) patients were considered potentially vulnerable. The most frequently reported sign of vulnerability was 'few supportive relations' (47% of the vulnerable patients). Most health-care personnel found it relevant to focus systematically on these patients. However, some were concerned that using the tool could prove to be stigmatising and were critical of attributing the vulnerability to the individual.

CONCLUSIONS

Most patients were considered in need of additional support because they lacked a social network or had difficulties communicating with health-care personnel. Applying a tool to identify potentially vulnerable patients was feasible and increased attention to this group of patients. However, the screening procedure was also questioned.

Feasibility testing of a supported education programme for students with severe mental disorders

INTRODUCTION

Most supported education studies stop at discussing the academic problems of students with severe mental diseases (SMDs) without going into testing of appropriate and culturally relevant supported education interventions required for academic reintegration of students with SMDs. In this context, the researcher felt the need to test the feasibility of a need-based supported education programme (SEP) for students with SMDs to help them achieving higher education goals.

METHODOLOGY

This study was reviewed and approved by the Institute's Ethics Committee (NIMHANS) and it was also registered in the Clinical Trials Registry - India (CTRI): CTRI/2018/07/014828. The study used mixed (qualitative and quantitative) research methodology with a combined approach of Action Research and Case Study in providing SEP to students with SMDs. Fourteen (n = 14) students who enrolled into the SEP were assessed on their self-esteem, sense of mastery, helping factors, needs and outcomes met from SEP. The SEP was provided for up to a maximum of 1 year based on the academic reintegration needs of the student.

RESULTS

The results indicated that there was a significant reduction in hindering factors (χ² = 9.41, p < .01) and increase in helping factors (χ² = 6.49, p < .05) and self-esteem (χ² = 10.3, p < .01) over the period of 1 year of the study. Qualitative results further reiterated increase in helping factors along with positive outcomes such as enhanced primary and secondary support, reasonable accommodation at academic institutions, individual behavioural changes in academics and increased awareness and knowledge about mental illness and welfare benefits.

CONCLUSION

The SEP was found to be feasible qualitatively and quantitatively in helping the students with SMDs to reintegrate into academics, improving their self-esteem, reducing their hindering factors, and improving their support system and helping factors.

Development and Feasibility Testing of a Brief Yoga Module on Well-being and Cognition of Postgraduate Mental Healthcare Students in Tertiary Settings

BACKGROUND

Mental health-care students experience stress and burnout during their training period. Yoga has been found to be helpful in improving one's mental health and well-being.

AIM

The aim of this study is to develop and test the feasibility of a brief yoga module for postgraduate mental health-care students.

METHODS

Amixed method design was used. Phase 1 involved development and validation of the yoga module using the qualitative exploratory method. Phase II tested the feasibility of the module on a sample of 28 first-year postgraduate students. These students participated in a 15-day (30 min/day) brief yoga module for improving their well-being and cognition (mirror neuron activation [MNA] and tower of London task as assessed on day 0, day 15 (2 weeks), and day 30 (4 weeks). Qualitative feedback of the student volunteers was also recorded.

RESULTS

Significant improvement in the well-being scores was observed in the students who adhered to the yoga practice after 2 weeks and 4 weeks. Functional near infra-red spectroscopy (fNIRS) data indicated that adherents showed significant activation of left somatosensory region of the brain and deactivation in the right primary somatosensory region during the static and active phase of the MNA task, respectively. Adherent group showed significant improvement in reaction time during "Zero-Moves" tasks of Tower of London. The qualitative thematic analysis showed that the module helped improve the well-being and mental health of the students.

CONCLUSION

The yoga program was found to have high need and medium to high feasibility. A systemic integration of student well-being-oriented interventions including yoga in the curriculum of postgraduate mental health-care courses is advocated.

Development and Testing of an Audio-Visual Self-Help Yoga Manual for Indian Caregivers of Persons with Schizophrenia Living in the Community: A Single-Blind Randomized Controlled Trial

Background:

To test the feasibility and effectiveness of an audio-visual self-help audio-visual yoga manual on burden of Indian caregivers of persons with schizophrenia, living in the community.

Methods:

An earlier developed yoga program for caregivers of schizophrenia was remodeled into an audio-visual self-help manual in three languages and validated by mental health and yoga experts. 48 consenting primary family caregivers of outpatients with schizophrenia were screened, recruited, and allotted randomly to Yoga or Care as Usual Group. Participants in Yoga group were taught yoga from the self-help manual (1 session of 1 h every month for 5 months). The caregivers were asked to follow the manual for the remaining month at home. Assessments of burden, perceived stress, quality of life, and anxiety-depression were conducted by a rater blind to the group status at baseline and at the end of every month.

Results:

Post factoring for missing data, Repeatedmeasure ANOVA was conducted; which showed that there was no significant difference between the group that practiced the selfhelp yoga manual and the care as usual group. The caregivers who practiced yoga at home maintained an average of 50% attendance and “very well” level of yoga performance.

Conclusion:

The audio-visual self-help yoga manual was found to be feasible to use by the caregivers even though its effectiveness could not be ascertained due to high attrition.

Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study

Background

Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages.

Objective

The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs.

Methods

We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline.

Results

Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t₆=–2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t₂₀=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol.

Conclusions

This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages.

Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs

BACKGROUND

Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT.

OBJECTIVE

To explore patients', parents', and health care professionals' views and attitudes toward using digital technology for remote monitoring during titration for ADHD.

METHODS

This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59).

RESULTS

All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management.

CONCLUSIONS

RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required.