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Feig EH, Szapary C, Harnedy LE, Castillo C, Thorndike AN, Psaros C, Millstein RA, Huffman JC. Using Positive Psychology to Address Emotional Barriers to Physical Activity After Bariatric Surgery: Proof-of-Concept Trial of the Gaining Optimism After Weight Loss Surgery (GOALS) Project. Cogn Behav Pract 2024; 31:189-202. [PMID: 38680521 PMCID: PMC11052544 DOI: 10.1016/j.cbpra.2023.02.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6-12 months post-MBS (M age of 46, 58% female, 67% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0-10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.
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Affiliation(s)
- Emily H Feig
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | | | | | | | - Jeff C Huffman
- Massachusetts General Hospital and Harvard Medical School
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Staguhn ED, Kirkhart T, Allen L, Campbell CM, Wegener ST, Castillo RC. Predictors of participation in online self-management programs: A longitudinal observational study. Rehabil Psychol 2024; 69:102-109. [PMID: 37956087 PMCID: PMC11059776 DOI: 10.1037/rep0000521] [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: 11/15/2023]
Abstract
PURPOSE/OBJECTIVE Lack of patient participation and engagement remains a barrier to implementing effective online self-management and behavioral health interventions. Identifying patient characteristics associated with engagement rates may lead to interventions that improve engagement in traditional and online self-management programs. In this study, two online self-management and recovery programs were evaluated to identify factors that predict patient engagement. RESEARCH METHOD/DESIGN Predictors were collected in a questionnaire at baseline before 435 participants started either of the two interventions. One or two online lessons were completed per week with seven or eight total lessons to complete in each program, and each lesson took about 20-30 min to finish. Full patient engagement was defined as completing all lessons and assessments in the program and partial engagement as attempting at least one lesson or assessment. RESULTS Predictors of full patient engagement were self-rated confidence in completing the program or being over 60 years of age. Predictors of at least partial patient engagement were experienced ordering online or being over 50 years of age. CONCLUSIONS/IMPLICATIONS Identifying profiles of individuals who predict poor engagement may improve implementation and the health outcomes of intervention programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Elena D. Staguhn
- Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health
- Physical Medicine and Rehabilitation, Johns Hopkins
Medicine
| | - Tricia Kirkhart
- Physical Medicine and Rehabilitation, Johns Hopkins
Medicine
| | - Lauren Allen
- Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health
| | | | | | - Renan C. Castillo
- Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health
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Cipta DA, Andoko D, Theja A, Utama AVE, Hendrik H, William DG, Reina N, Handoko MT, Lumbuun N. Culturally sensitive patient-centered healthcare: a focus on health behavior modification in low and middle-income nations-insights from Indonesia. Front Med (Lausanne) 2024; 11:1353037. [PMID: 38681051 PMCID: PMC11047771 DOI: 10.3389/fmed.2024.1353037] [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] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
Patient-centered, culturally sensitive healthcare acknowledges the profound impact of cultural beliefs on health behaviors and outcomes, particularly vital in low and middle-income countries (LMICs). Within Indonesia, distinct cultural factors are pivotal in empowering patients, necessitating their integration into healthcare practices. For example, the cultural concept of gotong royong, emphasizing communal collaboration, presents an opportunity to foster community support networks among patients. Moreover, honoring familial ties and involving family members in decision-making enhances patient empowerment. Acknowledging and incorporating spiritual and religious beliefs, which are deeply rooted in Indonesian culture, into healthcare interventions further augments patient empowerment and well-being. In LMICs, including Indonesia, achieving patient empowerment demands implementing critical strategies. Community-based interventions harness local resources and engage the community to drive health behavior change. Culturally sensitive communication bridges the gap between healthcare providers and patients, respecting language nuances and cultural norms. Patient education fosters a comprehensive understanding of health conditions, thereby encouraging active involvement in decision-making. Tailored behavior modification techniques, aligned with cultural beliefs and practices, support the adoption of healthier behaviors among patients. This review emphasizes the pivotal role of patient-centered, culturally sensitive healthcare in LMICs, particularly in Indonesia. It delves into strategies to promote health behavior change within these unique contexts, emphasizing the importance of cultural sensitivity and patient-centered care. The discourse also explores the cultural landscape impacting healthcare, acknowledging the challenges faced in delivering comprehensive healthcare services within these diverse cultural contexts. Additionally, it outlines innovative approaches and success stories in implementing patient-centered care, highlighting how cultural factors intersect with healthcare outcomes. By advocating for integrating culture-specific patient empowerment practices into healthcare methodologies, this article underscores the potential for improved health outcomes, heightened patient engagement, and the delivery of culturally relevant services within LMICs.
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Affiliation(s)
- D. A Cipta
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Psychiatry, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - D. Andoko
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - A. Theja
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - A. V. E. Utama
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - H. Hendrik
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - D. G. William
- School of Medicine, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - N. Reina
- School of Medicine, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - M. T. Handoko
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - N. Lumbuun
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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Borrelli B, Bartlett YK, Fulford D, Frasco G, Armitage CJ, Wearden A. Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial. JMIR Form Res 2024; 8:e54912. [PMID: 38573739 PMCID: PMC11027050 DOI: 10.2196/54912] [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] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. OBJECTIVE This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. METHODS Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. RESULTS There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI -0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=-0.19, SE 0.10; 95% CI -0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=-0.26, SE 0.15; 95% CI -0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. CONCLUSIONS The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, United States
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Y Kiera Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Daniel Fulford
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Greg Frasco
- Rafik B. Hariri Institute for Computing and Computational Science & Engineering, Boston University, Boston, MA, United States
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Greater Manchester Patient Safety Research Collaboration, National Institute for Health and Care Research, Manchester, United Kingdom
| | - Alison Wearden
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Distler KR, Lindsey MJ, Mims MH, Taylor MA, Hollingsworth JC. Primary Care Clinic Approaches to Facilitating Patient Health Behavior Change in Alabama. Cureus 2024; 16:e55973. [PMID: 38601414 PMCID: PMC11006427 DOI: 10.7759/cureus.55973] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Background Non-communicable chronic diseases (NCCDs), such as cardiovascular disease, diabetes, and cancer, are the leading cause of death and disability and the leading driver of healthcare costs in the U.S. It is estimated that 80% of chronic diseases and premature deaths are attributable to modifiable lifestyle factors related to smoking and alcohol intake, poor eating patterns, and physical inactivity. Inadequate sleep also plays a significant role. Among other directives, primary care providers (PCPs) have the opportunity to contribute to preventing and treating NCCD in their patients. Comprehensive, evidence-based behavioral counseling interventions are recommended to PCPs as a first-line approach to improving outcomes. However, presumably due to a lack of PCP time, training or resources, most patients report not receiving such services. Currently, the extent to which PCPs in Alabama offer or refer patients to health behavior change (HBC) services is unknown. Objectives This study aims to assess the following: (1) Alabama PCPs' current approaches in facilitating patient HBC in the domains of eating patterns, physical activity, sleep, and stress and (2) the likelihood of the Alabama PCPs referring patients to virtual HBC programs, once developed by an osteopathic medical school in the state. Methods Data were collected from clinic personnel who were knowledgeable regarding the clinic's approach to facilitating patient HBC via scripted telephone interviews and online surveys sent via email. The clinic list utilized for the study was derived from a list of VCOM-Auburn clinical preceptors. Primary care and specialty clinics were included. Data were analyzed descriptively to determine the number of clinics that (1) provide, recommend, or refer programs, services, or resources to patients to facilitate HBC related to eating patterns, physical activity, sleep, and stress management and (2) are likely to refer patients to free virtual HBC programs, once developed by an osteopathic medical school in the state. Results Of the 198 clinics that were contacted, 75 were excluded, 46 were "no response," 53 agreed to participate, and 50 completed the survey. Of the 50 clinics that completed the survey, 33 indicated offering resources or referrals for diet, 29 stated they offered resources or referral services for physical activity, 33 indicated offering resources or referrals for sleep, and 28 indicated offering or recommending resources for stress management to patients. Most of the clinics (29/50) felt that their patients would benefit most from a program that facilitates improvement in eating patterns, and 41/50 clinics said that they are either "somewhat" or "extremely" likely to refer patients to a free VCOM-Auburn HBC program, once available. Conclusions Findings indicate that a significant percentage of PCP clinics are not offering HBC resources to patients and that most PCP clinics would consider referring patients to free VCOM-Auburn HBC programs, once available. Phone data were significantly different from email data. The primary limitations were a low response rate and potential response bias.
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Affiliation(s)
- Kyle R Distler
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Marla Jo Lindsey
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Mary Hinson Mims
- Preventive Medicine, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
| | - Mary Ann Taylor
- Psychiatry and Neuro-behavioral Sciences, Center for Institutional, Faculty, and Student Success, Edward Via College of Osteopathic Medicine (VCOM-Auburn), Auburn, USA
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Park S, Lee J, Seok JW, Park CG, Jun J. Comprehensive lifestyle modification interventions for metabolic syndrome: A systematic review and meta-analysis. J Nurs Scholarsh 2024; 56:249-259. [PMID: 38009414 DOI: 10.1111/jnu.12946] [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: 05/10/2023] [Revised: 08/02/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Previous systematic reviews and meta-analyses have mainly focused on improvements in the number of metabolic syndrome risk factors and individual changes in each risk factor, making it challenging to examine the impact of comprehensive lifestyle modification interventions on adherence to recommended health behaviors. To address this gap, we conducted a systematic and meta-analysis aimed at identifying clinical parameter levels associated with lifestyle modification outcomes and adherence to recommended health behaviors for individuals with metabolic syndrome. METHODS A total of seven studies retrieved from four databases (CINAHL, Medline via PubMed, American Psychological Association PsycINFO, and Embase) were included in the review. The selected studies, which demonstrated improvements in health behaviors, all included diet and exercise as main factors of comprehensive lifestyle modification in home settings. RESULTS Our findings suggest that a 6-month comprehensive intervention including diet and exercise can be effective in decreasing glucose levels and systolic blood pressure. However, given the limited available data, further studies investigating the efficacy of interventions of varying durations are needed. DISCUSSION Although our review included a small number of studies, comprehensive lifestyle modifications consisting of at least two components (primarily diet and exercise) can improve health behaviors and some clinical parameters among individuals with metabolic syndrome. Future studies are needed to investigate the long-term effects of lifestyle modifications on health behavior adherence and explore effective interventions to address certain clinical parameters, such as high-density lipoprotein levels. Also, we recommend using objective and quantifiable measure to compare adherence to recommended lifestyle modifications across studies. CLINICAL RELEVANCE This research provides empirical evidence of the effectiveness of comprehensive lifestyle modification and emphasizes the need to develop long-term nursing strategies in public health that can be used to effectively manage metabolic syndrome.
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Affiliation(s)
- Sungwon Park
- Department of Health Behavior and Biological Sciences, School of Nursing, Michigan Society of Fellows 2022-2025, University of Michigan, Ann Arbor, Michigan, USA
| | - Jiwon Lee
- Department of Nursing, Dongnam Health University, Suwon, South Korea
| | - Jo Woon Seok
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jin Jun
- The Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, Ohio, USA
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Ahern J, Pleman B, O'Connor N, Silk H. Uptake of a Multilingual Intervention to Promote Toothbrushing in a Safety-Net Health Care System. Ann Fam Med 2024; 22:173. [PMID: 38527824 DOI: 10.1370/afm.3071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 03/27/2024] Open
Affiliation(s)
- John Ahern
- Cambridge Health Alliance, Department of Family Medicine, Cambridge, Massachusetts
| | - Brandon Pleman
- Cambridge Health Alliance, Department of Family Medicine, Cambridge, Massachusetts
| | - Nicole O'Connor
- Cambridge Health Alliance, Department of Family Medicine, Cambridge, Massachusetts
| | - Hugh Silk
- University of Massachusetts Chan Medical School, Department of Family Medicine and Community Health, Worcester, Massachusetts
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Stadler G, Scholz U, Bolger N, Shrout PE, Knoll N, Lüscher J. How is companionship related to romantic partners' affect, relationship satisfaction, and health behavior? Using a longitudinal dyadic score model to understand daily and couple-level effects of a dyadic predictor. Appl Psychol Health Well Being 2023; 15:1530-1554. [PMID: 37211027 DOI: 10.1111/aphw.12450] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Abstract
Companionship is related to better affect and relationship satisfaction, but few studies have examined both partners' perspectives over time and the link between companionship and health. In three intensive longitudinal studies (Study 1: 57 community couples; Study 2: 99 smoker-nonsmoker couples; Study 3: 83 dual-smoker couples), both partners reported daily companionship, affect, relationship satisfaction, and a health behavior (smoking in Studies 2 and 3). We proposed a dyadic score model that focuses on the couple level for companionship as a dyadic predictor with considerable shared variance. On days with higher companionship, couples reported better affect and relationship satisfaction. When partners differed in companionship, they also differed in affect and relationship satisfaction. For smoking, a different picture emerged: Whereas smokers with nonsmoking partners smoked less on average with higher companionship, smokers with smoking partners smoked more on days with higher companionship. Findings show companionship as a consequential relationship construct deserving further study. Using the dyadic score model acknowledged both partners' perspectives on companionship. It demonstrated higher precision for detecting effects of partner averages in a dyadic predictor compared with traditional approaches, tests for effects of partner differences in a dyadic predictor and in outcome while maintaining the focus on the dyad.
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Affiliation(s)
- Gertraud Stadler
- Charité-Universitätsmedizin Berlin, Berlin, Germany
- University of Aberdeen, Aberdeen, UK
- Columbia University, New York, New York, USA
| | - Urte Scholz
- University of Zurich, Zurich, Switzerland
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | | | | | - Nina Knoll
- Freie Universität Berlin, Berlin, Germany
| | - Janina Lüscher
- University of Zurich, Zurich, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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O'Reilly SL, Laws R, Maindal HT, Teede H, Harrison C, McAuliffe FM, Geraghty A, Campoy C, Bermúdez MG, Pirhonen L, Burden C, Davies A, Laursen DH, Skinner T. A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study. JMIR Res Protoc 2023; 12:e51431. [PMID: 37721798 PMCID: PMC10546269 DOI: 10.2196/51431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. OBJECTIVE We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. METHODS IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant's needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. RESULTS The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. CONCLUSIONS This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51431.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Rachel Laws
- School of Exercise and Nutrition Science, Deakin University, Burwood, Australia
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Fionnuala M McAuliffe
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling Geraghty
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, EURISTIKOS Excellence Centre for Paediatric Research, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Health Sciences Technological Park, Granada, Spain
| | - Mercedes G Bermúdez
- Department of Paediatrics, School of Medicine, EURISTIKOS Excellence Centre for Paediatric Research, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Health Sciences Technological Park, Granada, Spain
| | - Laura Pirhonen
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Christy Burden
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anna Davies
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Timothy Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, Australia
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Nehrkorn-Bailey AM, Rodriguez D, Forsyth G, Braun B, Burke K, Diehl M. Change in Views of Aging, Physical Activity, and Physical Health Over 8 Weeks: Results From a Randomized Study. J Aging Phys Act 2023; 31:666-678. [PMID: 36708712 PMCID: PMC10559658 DOI: 10.1123/japa.2022-0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/10/2022] [Revised: 10/20/2022] [Accepted: 11/12/2022] [Indexed: 01/29/2023]
Abstract
The AgingPLUS program targets motivational barriers, including negative views of aging, as mechanisms to increase adult physical activity. A pilot study was conducted to test the efficacy of this new program against a generic successful aging program. Fifty-six participants were randomly assigned to the AgingPLUS group, and 60 participants were assigned to the active control group. Repeated-measures multivariate analyses of variance assessed changes in views of aging, physical activity, blood pressure, and hand-grip strength from pretest (Week 0) to delayed posttest (Week 8). The Condition × Occasion interactions were nonsignificant; however, significant main effects for condition and occasion were found. Follow-up tests showed that views of aging were more positive, and physical activity had significantly increased at Week 8 for all participants. In addition, in the treatment group, elevated blood pressure had significantly decreased and hand-grip strength had significantly increased at Week 8. Despite the nonsignificant multivariate findings, the main effect findings provided partial support for the efficacy of the AgingPLUS program.
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Affiliation(s)
| | - Diana Rodriguez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO,USA
| | - Garrett Forsyth
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO,USA
| | - Barry Braun
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO,USA
| | - Kimberly Burke
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO,USA
| | - Manfred Diehl
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO,USA
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Kramer LL, van Velsen L, Mulder BC, Ter Stal S, de Vet E. Optimizing appreciation and persuasion of embodied conversational agents for health behavior change: A design experiment and focus group study. Health Informatics J 2023; 29:14604582231183390. [PMID: 37625392 DOI: 10.1177/14604582231183390] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Embodied Conversational Agents (ECAs) can increase user engagement and involvement and can strengthen the effect of an intervention on health outcomes that is provided via an ECA. However, evidence regarding the effectiveness of ECAs on health outcomes is still limited. In this article, we report on a study that has the goal to identify the effect of a match between a health topic and the ECAs' appearance on ratings of personality characteristics, persuasiveness and intention to use. We report on an online experiment with three different ECAs and three different health topics, conducted among 732 older adults. We triangulated the quantitative results with qualitative insights from a focus group. The results reveal that older adults prefer an ECA that has an appearance matching a certain health topic, resulting in higher ratings on persuasiveness and intention to use. Personality characteristics should be measured embedded within a health topic, but are not rated higher because of a match. We furthermore provide guidelines for designing the content of the ECA.
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Affiliation(s)
- Lean L Kramer
- Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, Enschede, Netherlands
| | - Bob C Mulder
- Wageningen University & Research, Wageningen, Netherlands
| | - Silke Ter Stal
- Roessingh Research and Development, Enschede, Netherlands
| | - Emely de Vet
- Wageningen University & Research, Wageningen, Netherlands
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12
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Williams KN, Quinn A, North H, Wang J, Pillarisetti A, Thompson LM, Díaz-Artiga A, Balakrishnan K, Thangavel G, Rosa G, Ndagijimana F, Underhill LJ, Kirby MA, Puzzolo E, Hossen S, Waller LA, Peel JL, Rosenthal JP, Clasen TF, Harvey SA, Checkley W. Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: the multi-country Household Air Pollution Intervention Network (HAPIN) trial. medRxiv 2023:2023.06.20.23291670. [PMID: 37425899 PMCID: PMC10327189 DOI: 10.1101/2023.06.20.23291670] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels. Methods The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n=1,590), with controls expected to continue cooking with biomass fuels (n=1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs). Results Fidelity and adherence to the HAPIN intervention were high. Median time required to refill LPG cylinders was 1 day (interquartile range 0-2). Although 26% (n=410) of intervention participants reported running out of LPG at some point, the number of times was low (median: 1 day [Q1, Q3: 1, 2]) and mostly limited to the first four months of the COVID-19 pandemic. Most repairs were completed on the same day as problems were reported. Traditional stove use was observed in only 3% of observation visits, and 89% of these observations were followed up with behavioral reinforcement. According to SUMs data, intervention households used their traditional stove a median of 0.4% of all monitored days, and 81% used the traditional stove <1 day per month. Traditional stove use was slightly higher post-COVID-19 (detected on a median [Q1, Q3] of 0.0% [0.0%, 3.4%] of days) than pre-COVID-19 (0.0% [0.0%, 1.6%] of days). There was no significant difference in intervention adherence pre- and post-birth. Conclusion Free stoves and an unlimited supply of LPG fuel delivered to participating homes combined with timely repairs, behavioral messaging, and comprehensive stove use monitoring contributed to high intervention fidelity and near-exclusive LPG use within the HAPIN trial.
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Affiliation(s)
- Kendra N. Williams
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Hayley North
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Jiantong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ajay Pillarisetti
- Division of Environmental Health Sciences, University of California at Berkeley, Berkeley, CA, USA
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Anaité Díaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Gurusamy Thangavel
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Lindsay J. Underhill
- Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, MO, USA
| | - Miles A. Kirby
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa Puzzolo
- Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua P. Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven A. Harvey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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13
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Michaelsen MM, Esch T. Understanding health behavior change by motivation and reward mechanisms: a review of the literature. Front Behav Neurosci 2023; 17:1151918. [PMID: 37405131 PMCID: PMC10317209 DOI: 10.3389/fnbeh.2023.1151918] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
The global rise of lifestyle-related chronic diseases has engendered growing interest among various stakeholders including policymakers, scientists, healthcare professionals, and patients, regarding the effective management of health behavior change and the development of interventions that facilitate lifestyle modification. Consequently, a plethora of health behavior change theories has been developed with the intention of elucidating the mechanisms underlying health behavior change and identifying key domains that enhance the likelihood of successful outcomes. Until now, only few studies have taken into account neurobiological correlates underlying health behavior change processes. Recent progress in the neuroscience of motivation and reward systems has provided further insights into the relevance of such domains. The aim of this contribution is to review the latest explanations of health behavior change initiation and maintenance based on novel insights into motivation and reward mechanisms. Based on a systematic literature search in PubMed, PsycInfo, and Google Scholar, four articles were reviewed. As a result, a description of motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) and their role in health behavior change processes is presented. Three central findings are discussed: (1) motivation and reward processes allow to distinguish between goal-oriented and stimulus-driven behavior, (2) approach motivation is the key driver of the individual process of behavior change until a new behavior is maintained and assertion motivation takes over, (3) behavior change techniques can be clustered based on motivation and reward processes according to their functional mechanisms into facilitating (= providing external resources), boosting (= strengthening internal reflective resources) and nudging (= activating internal affective resources). The strengths and limitations of these advances for intervention planning are highlighted and an agenda for testing the models as well as future research is proposed.
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14
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Magill M, Maisto S, Borsari B, Glass JE, Hallgren K, Houck J, Kiluk B, Kuerbis A. Addictions treatment mechanisms of change science and implementation science: A critical review. Alcohol Clin Exp Res (Hoboken) 2023; 47:827-839. [PMID: 36913967 PMCID: PMC10314994 DOI: 10.1111/acer.15053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/05/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
Abstract
This manuscript aims to contribute to the next phase of mechanisms of behavior change (MOBC) science on alcohol or other drug use. Specifically, we encourage the transition from a basic science orientation (i.e., knowledge generation) to a translational science orientation (i.e., knowledge application or Translational MOBC Science). To inform that transition, we examine MOBC science and implementation science and consider how these two research areas can intersect to capitalize on the goals, strengths, and key methodologies of each. First, we define MOBC science and implementation science and offer a brief historical rationale for these two areas of clinical research. Second, we summarize similarities in rationale and discuss two scenarios where one draws from the other-MOBC science on implementation strategy outcomes and implementation science on MOBC. We then focus on the latter scenario, and briefly review the MOBC knowledge base to consider its readiness for knowledge translation. Finally, we provide a series of research recommendations to facilitate the translation of MOBC science. These recommendations include: (1) identifying and targeting MOBC that are well suited for implementation, (2) use of MOBC research results to inform broader health behavior change theory, and (3) triangulation of a more diverse set of research methodologies to build a translational MOBC knowledge base. Ultimately, it is important for gains borne from MOBC science to affect direct patient care, while basic MOBC research continues to be developed and refined over time. Potential implications of these developments include greater clinical significance for MOBC science, an efficient feedback loop between clinical research methodologies, a multi-level approach to understanding behavioral change, and reduced or eliminated siloes between MOBC science and implementation science.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stephan Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Brian Borsari
- Department of Psychiatry, San Francisco Veteran’s Administration, University of California – San Francisco, San Francisco, California, USA
| | - Joseph E. Glass
- Kaiser Permanente – Washington Health Research Institute, Seattle, Washington, USA
| | - Kevin Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jon Houck
- Mind Research Network, University of New Mexico, Albuquerque, New Mexico, USA
| | - Brian Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alexis Kuerbis
- Silberman School of Social Work, CUNY Hunter College, New York, New York, USA
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15
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Hicks JL, Boswell MA, Althoff T, Crum AJ, Ku JP, Landay JA, Moya PML, Murnane EL, Snyder MP, King AC, Delp SL. Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective. Annu Rev Public Health 2023; 44:131-150. [PMID: 36542772 PMCID: PMC10523351 DOI: 10.1146/annurev-publhealth-060220-041643] [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: 12/24/2022]
Abstract
Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as anexemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors.
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Affiliation(s)
- Jennifer L Hicks
- Department of Bioengineering, Stanford University, Stanford, California, USA;
| | - Melissa A Boswell
- Department of Bioengineering, Stanford University, Stanford, California, USA;
| | - Tim Althoff
- Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington, USA
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Joy P Ku
- Department of Bioengineering, Stanford University, Stanford, California, USA;
| | - James A Landay
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Paula M L Moya
- Department of English and the Center for Comparative Studies in Race and Ethnicity, Stanford University, Stanford, California, USA
| | | | - Michael P Snyder
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Abby C King
- Department of Epidemiology and Population Health, and Department of Medicine (Stanford Prevention Research Center), Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Scott L Delp
- Department of Bioengineering and Department of Mechanical Engineering, Stanford University, Stanford, California, USA
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16
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Berdal G, Sand-Svartrud AL, Linge AD, Aasvold AM, Tennebø K, Eppeland SG, Hagland AS, Ohldieck-Fredheim G, Valaas HL, Bø I, Klokkeide Å, Sexton J, Azimi M, Dager TN, Kjeken I. Bridging gaps across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases: Results from a stepped-wedge cluster randomized controlled trial. Clin Rehabil 2023:2692155231153341. [PMID: 36862585 PMCID: PMC10387727 DOI: 10.1177/02692155231153341] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. DESIGN A pragmatic stepped-wedge cluster randomized trial. SETTING Eight rehabilitation centers in secondary healthcare, Norway. PARTICIPANTS A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). INTERVENTIONS A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients' needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. MAIN MEASURES Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients' goal attainment measured by the Patient Specific Functional Scale (0-10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. RESULTS No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: -0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. CONCLUSION The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group.
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Affiliation(s)
- Gunnhild Berdal
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Anne-Lene Sand-Svartrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Anita Dyb Linge
- 574813Muritunet Rehabilitation Centre, Valldal, Ålesund, Norway
| | | | - Kjetil Tennebø
- 158956Valnesfjord Health Sports Centre, Valnesfjord, Norway
| | - Siv G Eppeland
- Department of Physiotherapy, Sørlandet Hospital, Arendal, Norway
| | | | | | | | - Ingvild Bø
- Department of Rehabilitation, Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Åse Klokkeide
- Rehabilitering Vest Rehabilitation Centre, Haugesund, Norway
| | - Joseph Sexton
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Maryam Azimi
- REMEDY Patient Advisory Board, Diakonhjemmet Hospital, Oslo, Norway
| | - Turid N Dager
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
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Standley K, Ravesloot C, Sage R, Sondag KA. Health Coaching for People With Disabilities: An Exploratory Mixed-Methods Study. Am J Health Promot 2023; 37:345-355. [PMID: 35722956 DOI: 10.1177/08901171221109524] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To expand the reach of health-promotion efforts for people with disabilities, we piloted a health-coaching intervention with a disability-specific curriculum. We evaluated the intervention's effects on health-related quality of life and health behavior change. DESIGN Mixed-methods research design using pre-post measures and semi-structured interviews. SETTING/PARTICIPANTS A convenience sample of community-dwelling adults with disabilities (n = 39). INTERVENTION Participants engaged in a curriculum-based health coaching intervention, titled Health My Way, which used weekly one-on-one coaching for up to 12 weeks. METHODS Participants completed pre- and post-intervention surveys including questions from the Health-Related Quality of Life (HRQOL) measure and the Health-Promoting Lifestyle Profile II. A subset of participants completed in-depth interviews to explore how health coaching influences health behavior change (n = 12). RESULTS We found statistically significant effects on poor-health days due to physical and mental health, and effects on physical activity. We saw additional effects with engagement in relevant curriculum content. Qualitative main themes (tailoring of information, enthusiasm for personally meaningful goals, and social support) indicated processes by which health coaching supported health behavior changes. CONCLUSIONS The results of this pilot study indicate health coaching appears to be effective for improving HRQOL and health behavior, especially physical activity, for people with disabilities. Apparent key factors include enthusiasm for personally meaningful goals, having tailored information, and social support.
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Affiliation(s)
- Krys Standley
- Research and Training Center on Disability in Rural Communities, 307078University of Montana, Missoula, MT, USA
| | - Craig Ravesloot
- Research and Training Center on Disability in Rural Communities, 307078University of Montana, Missoula, MT, USA
| | - Rayna Sage
- Research and Training Center on Disability in Rural Communities, 307078University of Montana, Missoula, MT, USA
| | - K Ann Sondag
- School of Public and Community Health Sciences, 307078University of Montana, Missoula, MT, USA
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18
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Aggarwal A, Tam CC, Wu D, Li X, Qiao S. Artificial Intelligence-Based Chatbots for Promoting Health Behavioral Changes: Systematic Review. J Med Internet Res 2023; 25:e40789. [PMID: 36826990 PMCID: PMC10007007 DOI: 10.2196/40789] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [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: 07/05/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based chatbots can offer personalized, engaging, and on-demand health promotion interventions. OBJECTIVE The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. METHODS A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. CONCLUSIONS AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
| | - Cheuk Chi Tam
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
| | - Dezhi Wu
- UofSC Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, United States
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
- UofSC Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- SC SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, United States
- UofSC Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC, United States
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Garn AC, Simonton KL. Prolonged Sitting in University Students: An Intra-Individual Study Exploring Physical Activity Value as a Deterrent. Int J Environ Res Public Health 2023; 20:1891. [PMID: 36767258 PMCID: PMC9915133 DOI: 10.3390/ijerph20031891] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
University students are a subpopulation of young adults highly susceptible to prolonged bouts of sitting. The purpose of this study was to investigate university students' intra-individual patterns of prolonged daily sitting, exploring gender and physical activity value beliefs as covariates. A total of 71 students reported the number of days each week they spent in bouts of prolonged sitting (2 + continuous hours) over a five-week timeframe. The findings revealed that at the beginning of the study, the students spent about four days per week in prolonged bouts of sitting although there was substantial variability in the sample. Intra-individual changes over the five weeks occurred in a non-linear fashion with a variability in these trajectories. Men reported approximately one less day of prolonged sitting per week although gender did not predict changes over time. Physical activity value beliefs were negatively related to prolonged bouts of sitting when averaged across time. The results illustrate the variable nature of prolonged sitting in university student populations, highlighting the need for implementing individualized intervention strategies targeting sedentary behavior.
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Affiliation(s)
- Alex C. Garn
- School of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Kelly L. Simonton
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA
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20
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Schwebel DC. The forgotten facet of firearms safety: Unintentional gun injuries and deaths in the United States. Front Public Health 2023; 11:1137725. [PMID: 37033015 PMCID: PMC10076623 DOI: 10.3389/fpubh.2023.1137725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
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21
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Holder C, Krishnamurthi R, Theadom A. Exploring facilitators and barriers to long-term behavior change following health-wellness coaching for stroke prevention: A qualitative study conducted in Auckland, New Zealand. Brain Behav 2023; 13:e2671. [PMID: 36510702 PMCID: PMC9847597 DOI: 10.1002/brb3.2671] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Health-wellness coaching (HWC) has grown in popularity as a means of empowering individuals to take responsibility for their health behavior and make lifestyle changes to reduce their risk of stroke. Understanding the facilitators and barriers to long-term behavior change is key if preventive strategies such as HWC are to be robust and effective. This study aimed to explore the experiences of people at risk of stroke after receiving HWC for stroke prevention, specifically the facilitators and barriers to long-term behavior change from the perspective of study participants. METHODS All participants received HWC as part of a randomized controlled trial 3 years earlier. Semi-structured telephone interviews were conducted with eight participants from the trial sample. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key concepts and themes. RESULTS Three overarching themes were identified: "Awakening of the mind" captured the importance of seeing the bigger picture, recognizing the impact of potential disease and using skills and tools to support decision-making. "It's not just about health behavior" conveyed the importance of being respectfully responsive to individual need and addressing emotional well-being alongside physical health. "Social connectedness" encapsulated the significance of community engagement, accountability, and paying it forward. CONCLUSIONS Enhancing awareness of personal risk and the impact of potential disease are facilitators of long-term behavior change and should be incorporated into coaching conversations. This supports the process of "waking up" to health needs and the possibility of change, which are important precursors to long-term change. Health coaching should be responsive to individual need, with emotional well-being, happiness, and life satisfaction being addressed alongside physical health. The opportunity to develop skills to support decision-making and self-management should be included in coaching initiatives, to enhance self-efficacy and help facilitate long-term behavior change.
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Affiliation(s)
- Caroline Holder
- National Institute of Stroke and Applied Neurosciences (NISAN), Auckland, New Zealand
| | | | - Alice Theadom
- Faculty of Health and Environmental Sciences, Auckland, New Zealand
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22
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Potempa K, Butterworth S, Flaherty-Robb M, Calarco M, Marriott D, Ghosh B, Gabarda A, Windsor J, Potempa S, Laughlin C, Harden K, Schmidt P, Ellis A, Furspan P. The Impact of Nurse Health-Coaching Strategies on Cognitive-Behavioral Outcomes in Older Adults. Int J Environ Res Public Health 2022; 20:416. [PMID: 36612737 PMCID: PMC9819046 DOI: 10.3390/ijerph20010416] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
The practice of nurse health coaching (NHC) draws from the art and science of nursing, behavioral sciences, and evidence-based health-coaching methods. This secondary analysis of the audio-recorded natural language of participants during NHC sessions of our recent 8-week RCT evaluates improvement over time in cognitive−behavioral outcomes: change talk, resiliency, self-efficacy/independent agency, insight and pattern recognition, and building towards sustainability. We developed a measurement tool for coding, Indicators of Health Behavior Change (IHBC), that was designed to allow trained health-coach experts to assess the presence and frequency of the indicators in the natural language content of participants. We used a two-step method for randomly selecting the 20 min audio-recorded session that was analyzed at each time point. Fifty-six participants had high-quality audio recordings of the NHC sessions. Twelve participants were placed in the social determinants of health (SDH) group based on the following: low income (<USD 20,000/year), early-onset hypertension, and social disadvantages. Our analyses significantly improved change talk and the other four factors over time. Our factor analyses indicated two distinct factors at each measurement point of the study, demonstrating the stability of the outcome measures over time. Our newly developed measurement tool, IHBC, proved stable in structure over time and sensitive to change. This NHC program shows promise in improving cognitive−behavioral indicators associated with health behavior change in both non-SDH and SDH individuals.
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Affiliation(s)
- Kathleen Potempa
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Susan Butterworth
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | | | - Margaret Calarco
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Deanna Marriott
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bidisha Ghosh
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | - Stacia Potempa
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Candia Laughlin
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Karen Harden
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Patricia Schmidt
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alexis Ellis
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Philip Furspan
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
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23
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Berlin P, Seifart C, von Blanckenburg P. Validation of the Readiness for End-of-Life Conversations (REOLC) scale in a German hospital setting. PEC Innov 2022; 1:100045. [PMID: 37213740 PMCID: PMC10194301 DOI: 10.1016/j.pecinn.2022.100045] [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] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 05/23/2023]
Abstract
Objective For every health behavior, readiness to engage is a necessary and crucial foundation for following conversations, interventions or behavior changes. The present study aims to support a one-factor structure for the Readiness for End-of-Life Conversations (REOLC) scale (Berlin et al., 2021) in a population of cancer patients (N = 295). Methods For validation purposes, data of patients participating in a screening development study at a university clinic was used. Model adequacy was analyzed with structural equation modelling and controlled for with goodness of fit indices: χ2-test, SRMR, rRMSEA. Discriminant and convergent validity were assessed with correlations of REOLC and psychological or health behavior measures. Results Factor structure was supported with good fit indices, discriminant validity and convergent validity. Readiness correlated significantly with age and reported death anxiety. Conclusion The REOLC scale is a reliable instrument to assess cancer patients' readiness for end-of-life conversations. Future studies may further address moderating and mediating effects of socio-demographic, medical and psychological factors. Innovation The assessment of readiness may further indicate anxiety levels of cancer patients and enables practitioners to provide interventions accordingly. However, in a clinical setting and especially for patients with a palliative prognosis, end-of-life care conversations may need to be introduced early.
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Affiliation(s)
- Pia Berlin
- Department of Psychology, Philipps-University of Marburg, Germany
- Corresponding author at: Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstr. 18, 35037 Marburg, Germany.
| | - Carola Seifart
- Department of Medicine, Research Group Medical Ethics, Philipps-University of Marburg, Germany
- University clinic of Gießen and Marburg, Marburg, Germany
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Abstract
Mental Contrasting with Implementation Intentions (MCII) is a self-regulation strategy that combines the strategies mental contrasting (MC) in which individualscontrast a desired future with the current reality with the strategy of forming implementation intentions (II), which involves making concrete if-then plans (implementation intentions, II) to overcome the obstacles standing in the way of the desired future. Numerous studies across behavioral domains have demonstrated the effectiveness of this strategy in supporting people to adopt health-promoting behaviors or changing unhealthy behaviors. However, research on MCII has so far neglected the applicability of the concept in media-mediated persuasive health communication. This conceptual review aims to demonstrate and examine the potentials and effects of MCII as a technique to tailor media-mediated persuasive health messages and their dissemination through different media channels. In doing so, it draws on existing models of health behavior change, especially individuals' threat and coping appraisals. Potential effects of MCII on these cognitive factors are discussed, and practical implications for health message design are outlined.
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Affiliation(s)
- Alexander Ort
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Andreas Fahr
- Department of Communication and Media Research, University of Fribourg, Fribourg, Switzerland
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25
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Brown JM, Stein JS. Putting prospection into practice: Methodological considerations in the use of episodic future thinking to reduce delay discounting and maladaptive health behaviors. Front Public Health 2022; 10:1020171. [PMID: 36408004 PMCID: PMC9669959 DOI: 10.3389/fpubh.2022.1020171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
In recent years, episodic future thinking (EFT) has emerged as a promising behavioral intervention to reduce delay discounting or maladaptive health behaviors; however, considerable methodological heterogeneity in methods for eliciting engagement in EFT has been observed in prior research. In this narrative review, we briefly describe methods for generating EFT cues, the content of EFT cues, common control conditions for experiments utilizing EFT, and considerations for cue delivery and implementation. Where possible, we make suggestions for current best practices in each category while identifying gaps in knowledge and potential areas of future research. Finally, we conclude by using the NIH Stage model to better frame the current state of the literature on EFT and propose gaps to be addressed if EFT is to be both an efficacious and effective behavioral intervention.
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Affiliation(s)
- Jeremiah Michael Brown
- Fralin Biomedical Research Institute, Virginia Tech Carilion, Roanoke, VA, United States
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Jeffrey Scott Stein
- Fralin Biomedical Research Institute, Virginia Tech Carilion, Roanoke, VA, United States
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, United States
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26
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Sparapani VDC, Fels S, Kamal N, Ortiz La Banca R, Nascimento LC. A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study. J Diabetes Sci Technol 2022; 16:1444-1450. [PMID: 34044626 PMCID: PMC9631520 DOI: 10.1177/19322968211017555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors. METHODS This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children's learning needs and behaviors, that were considered to design The Heroes of Diabetes-the power of knowledge. RESULTS The results presented the process of designing 4 mini games with its description and theory foundation to reach children's lack of understanding about T1D, insulin's role, SMBG requirements, food groups and physical activity's role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features. CONCLUSIONS The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.
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Affiliation(s)
- Valéria de Cássia Sparapani
- Department of Nursing, Santa Catarina
Federal University, Florianopolis, SC, Brazil
- Valéria de Cássia Sparapani, PhD, RN,
Department of Nursing, Campus Universitário. Trindade, CEP 88040-970.
Florianópolis, SC 88040-900, Brazil.
| | - Sidney Fels
- Electrical and Computer Engineering,
University of British Columbia, Vancouver, BC, USA
| | - Noreen Kamal
- Department of Industrial Engineering,
Dalhousie University, Halifax, NS, Canada
| | - Rebecca Ortiz La Banca
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
| | - Lucila Castanheira Nascimento
- Department of Maternal-Infant and
Public Health Nursing, Ribeirao Preto College of Nursing, University of Sao Paulo,
WHO Collaborating Center for Nursing Research Development, SP, Brazil
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Qian T, Walton AE, Collins LM, Klasnja P, Lanza ST, Nahum-Shani I, Rabbi M, Russell MA, Walton MA, Yoo H, Murphy SA. The microrandomized trial for developing digital interventions: Experimental design and data analysis considerations. Psychol Methods 2022; 27:874-894. [PMID: 35025583 PMCID: PMC9276848 DOI: 10.1037/met0000283] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 11/08/2022]
Abstract
Just-in-time adaptive interventions (JITAIs) are time-varying adaptive interventions that use frequent opportunities for the intervention to be adapted-weekly, daily, or even many times a day. The microrandomized trial (MRT) has emerged for use in informing the construction of JITAIs. MRTs can be used to address research questions about whether and under what circumstances JITAI components are effective, with the ultimate objective of developing effective and efficient JITAI. The purpose of this article is to clarify why, when, and how to use MRTs; to highlight elements that must be considered when designing and implementing an MRT; and to review primary and secondary analyses methods for MRTs. We briefly review key elements of JITAIs and discuss a variety of considerations that go into planning and designing an MRT. We provide a definition of causal excursion effects suitable for use in primary and secondary analyses of MRT data to inform JITAI development. We review the weighted and centered least-squares (WCLS) estimator which provides consistent causal excursion effect estimators from MRT data. We describe how the WCLS estimator along with associated test statistics can be obtained using standard statistical software such as R (R Core Team, 2019). Throughout we illustrate the MRT design and analyses using the HeartSteps MRT, for developing a JITAI to increase physical activity among sedentary individuals. We supplement the HeartSteps MRT with two other MRTs, SARA and BariFit, each of which highlights different research questions that can be addressed using the MRT and experimental design considerations that might arise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Sales AE, Farr SL, Spertus JA. The Influence of Health Behavior Theory on Implementation Practice and Science: Brief Review and Commentary. Pharmacy (Basel) 2022; 10:115. [PMID: 36136848 DOI: 10.3390/pharmacy10050115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
As research defines new treatments and policies to improve the health of patients, an increasing challenge has been to translate these insights into routine clinical practice to benefit patients and society. An important exploration is how theories of human behavior change fit into the science of implementation and quality improvement. In this paper, we begin with a brief review of the intellectual roots of implementation science and quality improvement, followed by a discussion of how theories and principles of behavior change can inform both goals and challenges in using behavior change theories. The insights offered through health behavior change theory have led to changes in how we plan for implementation and select, develop, design and tailor implementation interventions and strategies. While the degree to which organizational and external contexts influence the behavior of providers in these organizations varies widely, some degree of context external to the individual is important and needs adequate consideration. In short, health behavior change theory is essential but not sufficient to integrate in most implementation efforts, where priority must be given to both individual factors and contexts in which individuals operate.
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29
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Gong L, Jiang H, Wu X, Kong Y, Gao Y, Liu H, Guo Y, Hu D. Exploring Users' Health Behavior Changes in Online Health Communities: Heuristic-Systematic Perspective Study. Int J Environ Res Public Health 2022; 19:ijerph191811783. [PMID: 36142055 PMCID: PMC9517559 DOI: 10.3390/ijerph191811783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 06/10/2023]
Abstract
(1) Background: With the continuous advancement of internet technology, use of the internet along with medical service provides a new solution to solve the shortage of medical resources and the uneven distribution of available resources. Online health communities (OHCs) that emerged at this historical moment have flourished with various advantages, such as being free from location and time constraints. Understanding users' behavior changes via engagement in OHCs is necessary to support the development of internet medicine and promote public health. (2) Methods: The hypotheses of our research model were developed based on the protective action decision model (PADM) and heuristic-systematic model (HSM). A questionnaire was developed with seven constructs through previous studies and verified using a presurvey. Our survey respondents are online health community users. We used structural equation modelling to test the research hypotheses. (3) Results: The results of the analysis of 290 valid samples showed that the research model fit the data collected well. The perceived benefits (PB) positively affect information needs (IN) (beta = 0.280, p < 0.001, R2 = 0.252), thereby promoting users' engagement in OHCs (EOHCs) (beta = 0.353, p < 0.001, R2 = 0.387); EOHCs has a significant positive impact on health behavior change (HBC) (beta = 0.314, p < 0.001), and it also significantly positively affects users' health behavior change through systematic processing indirectly (beta = 0.252, p < 0.001, R2 = 0.387). (4) Conclusions: Our study offers support for the usefulness of the PADM and HSM in explaining users' health behavior changes. For practitioners, this study introduces influence processes as policy tools that managers can employ for health-promoting with mHealth.
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Affiliation(s)
- Liyue Gong
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
| | - Hao Jiang
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
| | - Xusheng Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen 518028, China
| | - Yi Kong
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
| | - Yunyun Gao
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
| | - Hao Liu
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
| | - Yi Guo
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
| | - Dehua Hu
- Department of Biomedical Information, School of Life Sciences, Central South University, Changsha 410013, China
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30
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Lee D, Rundle-Thiele S, Wut TM, Li G. Increasing Seasonal Influenza Vaccination among University Students: A Systematic Review of Programs Using a Social Marketing Perspective. Int J Environ Res Public Health 2022; 19:ijerph19127138. [PMID: 35742412 PMCID: PMC9223456 DOI: 10.3390/ijerph19127138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
The health and economic consequences of seasonal influenza present great costs to communities. Promoting voluntary uptake of the seasonal influenza vaccine among university students, particularly during the COVID-19 pandemic, can deliver protective effects for both individuals and the wider community. Vaccine uptake will be greatest when more of the social marketing benchmarks are applied. This systematic review summarizes evidence from programs aiming to increase seasonal influenza vaccination among university students. Six major electronic databases for health promotion studies (PubMed, EBSCO, ProQuest, Ovid, Web of Science, and ScienceDirect) were searched in November 2021 to capture peer-reviewed studies reporting field trials that have sought to increase seasonal influenza vaccination in university student populations, without any restrictions regarding the publication period. Following PRISMA guidelines, this paper identified 12 peer-reviewed studies that were conducted in the field in the United States, Australia, and Spain. Three studies were targeted at healthcare students and the rest focused on wider university student populations. Studies were narratively summarized, evidence of social marketing principles were identified, and quantitative outcomes were meta-analyzed. The findings indicate that none of the field studies, even a self-classified social marketing study, had adopted all eight of the social marketing benchmarks in program design and implementation. The two studies that only used promotion, but not other marketing-mix and social marketing principles, reported increases in students’ intention to be vaccinated but not actual behavior. Given that change is more likely when more social benchmarks are applied, this paper identifies activities that can be included in flu vaccine programs to improve flu vaccine uptake rates. The analysis highlights a lack of field studies focusing on increasing rates of vaccination behavior as research outcomes in countries beyond the United States.
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Affiliation(s)
- Daisy Lee
- School of Professional Education and Executive Development, The Hong Kong Polytechnic University, Hong Kong, China; (T.M.W.); (G.L.)
- Correspondence:
| | | | - Tai Ming Wut
- School of Professional Education and Executive Development, The Hong Kong Polytechnic University, Hong Kong, China; (T.M.W.); (G.L.)
| | - Gabriel Li
- School of Professional Education and Executive Development, The Hong Kong Polytechnic University, Hong Kong, China; (T.M.W.); (G.L.)
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Marom P, Zalcman BG, Dankner R. Association between Self-Classification of COVID-19 Risk Levels and Adverse Lifestyle Changes among Physically Active Older Adults Following the Coronavirus Outbreak. Int J Environ Res Public Health 2022; 19:ijerph19127039. [PMID: 35742285 PMCID: PMC9222379 DOI: 10.3390/ijerph19127039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has imposed barriers to a healthy lifestyle, especially for older adults who are considered to be at a high-risk of infection. This study examined the associations between negative changes and the self-classification to COVID-19 risk level among physically active older adults who are members of a nationwide health club chain. A cross-sectional digital survey was sent to 19,160 older adults (age ≥ 65). The data collected included information on the subjects’ self-classification to the COVID-19 high-risk group (HRG) and changes in physical activity (PA), body weight, and smoking habits since the outbreak. Logistic regression models were used to investigate the associations between the dependent variables of ‘experienced a negative change’ and the independent variables. Of the 1670 survey respondents, 78.3% classified themselves as COVID-19 HRG. Over half of the respondents reported a reduction in PA hours, 26.6% reported weight gain, and 17.7% of smokers increased their amount of smoking. A self-classification to the HRG was associated with 1.46 (95%CI 1.10−1.93, p < 0.009) and 1.67 (95%CI 1.21−2.31, p < 0.002) greater odds for reduced hours of exercise and weight gain compared to the not high-risk group, respectively. Decision makers should consider how policies may cause barriers to a healthy lifestyle and develop risk communication strategies to encourage positive health-related behaviors, even during a pandemic.
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Affiliation(s)
- Pnina Marom
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel-Aviv 6772829, Israel;
| | - Beth G. Zalcman
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel-Aviv 6772829, Israel;
| | - Rachel Dankner
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel-Aviv 6772829, Israel;
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262100, Israel
- Correspondence: ; Tel.: +972-73-2701613
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Scherer EA, Kim SJ, Metcalf SA, Sweeney MA, Wu J, Xie H, Mazza GL, Valente MJ, MacKinnon DP, Marsch LA. Momentary Self-regulation: Scale Development and Preliminary Validation. JMIR Ment Health 2022; 9:e35273. [PMID: 35536605 PMCID: PMC9131140 DOI: 10.2196/35273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Self-regulation refers to a person's ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-regulation and thus cannot aid in understanding potential malleable processes of self-regulation that may occur in response to the daily environment. OBJECTIVE This study aims to develop a brief, psychometrically sound momentary self-regulation scale that can be practically administered through participants' mobile devices at a momentary level. METHODS This study was conducted in 2 phases. In the first phase, in a sample of 522 adults collected as part of a larger self-regulation project, we examined 23 previously validated assessments of self-regulation containing 594 items in total to evaluate the underlying structure of self-regulation via exploratory and confirmatory factor analyses. We then selected 20 trait-level items to be carried forward to the second phase. In the second phase, we converted each item into a momentary question and piloted the momentary items in a sample of 53 adults over 14 days. Using the results from the momentary pilot study, we explored the psychometric properties of the items and assessed their underlying structure. We then proposed a set of subscale and total score calculations. RESULTS In the first phase, the selected individual-level items appeared to measure 4 factors of self-regulation. The factors identified were perseverance, sensation seeking, emotion regulation, and mindfulness. In the second phase of the ecological momentary assessment pilot, the selected items demonstrated strong construct validity as well as predictive validity for health risk behaviors. CONCLUSIONS Our findings provide preliminary evidence for a 12-item momentary self-regulation scale comprising 4 subscales designed to capture self-regulatory dynamics at the momentary level.
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Affiliation(s)
- Emily A Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Health Communication and Digital Innovation, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Mary Ann Sweeney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jialing Wu
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- School of Media and Design, Shanghai JiaoTong University, Shanghai, China
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Gina L Mazza
- Department of Psychology, Arizona State University, Tempe, AZ, United States
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, United States
| | - Matthew J Valente
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Kinouchi K, Ohashi K. Assessing Engagement With Patient-Generated Health Data Recording and Its Impact on Health Behavior Changes in Multicomponent Interventions: Supplementary Analysis. JMIR Form Res 2022; 6:e35471. [PMID: 35503411 PMCID: PMC9115657 DOI: 10.2196/35471] [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: 12/09/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
Background The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients’ decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients’ health behavior changes remains unclear. Objective This study aimed to assess patients’ engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. Methods This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients’ engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). Results The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). Conclusions The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients’ engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes.
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Affiliation(s)
- Kaori Kinouchi
- Department of Children and Women's Health, Area of integrated Health and Nursing Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Male D, Fergus K, Yufe S. 'Weighing' Losses and Gains: Evaluation of the Healthy Lifestyle Modification After Breast Cancer Pilot Program. Front Psychol 2022; 13:814671. [PMID: 35401377 PMCID: PMC8992775 DOI: 10.3389/fpsyg.2022.814671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/14/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This pilot study sought to develop and evaluate a novel online group-based intervention (Healthy Lifestyle Modification after Breast Cancer; HLM-ABC) to help breast cancer survivors (BCSs) make healthy lifestyle changes intended to yield not only beneficial physical outcomes (i.e., weight loss, reduced body mass index) but also greater behavioral (e.g., increased physical activity, healthier eating), and psychosocial well-being (e.g., self-efficacy, motivation, body image). Methods An exploratory single-arm, mixed-method triangulation design was employed to evaluate the feasibility and preliminary effectiveness of the HLM-ABC intervention for overweight BCSs. Fourteen women participated in the 10-week intervention and completed quantitative measures of the above-mentioned outcomes at baseline, post-treatment, 6-month, and 12-month follow-up time points. Qualitative data were obtained post-treatment via semi-structured interviews and a treatment satisfaction questionnaire. Results Participants lost an average of 2.83% of their baseline weight (M = 196.65; SD = 38.59) by 1-year follow-up (M = 191.29; SD = 33.91), equal to a small effect size (d = -0.37). Despite achieving only modest weight loss, participants achieved meaningful gains in the form of increased physical activity (d = 0.2), discovery of gratifying movement, more intuitive eating habits (d = 1.12), greater bodily and emotional awareness, and positive shifts in beliefs about being able to make healthy choices regarding food (d = 0.63) and physical activity (d = 0.38). Furthermore, they demonstrated a slight improvement in body image (d = 0.36) and described feeling more self-compassionate, empowered, and acknowledging of variables beyond control (i.e., hormonal therapy, unsatisfactory surgery) that can present barriers to change. Conclusion After completing a 10-week online program, participants achieved meaningful and lasting changes on a number of healthful indicators, even when this did not correspond with a significant reduction in weight. Findings highlight the complex, multifaceted nature of "health" and lend support for promotion of healthier lifestyle following cancer treatment that encompasses not only physical weight, but also behavior, psychosocial well-being, and (often unmodifiable) circumstances such as life-preserving hormonal treatments.
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Affiliation(s)
- Dana Male
- Tom Baker Cancer Centre (TBCC), Department of Psychosocial Oncology, Alberta Health Services, Calgary, AB, Canada
- Psychosocial Oncology Laboratory, Department of Psychology, York University, Toronto, ON, Canada
| | - Karen Fergus
- Psychosocial Oncology Laboratory, Department of Psychology, York University, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shira Yufe
- Psychosocial Oncology Laboratory, Department of Psychology, York University, Toronto, ON, Canada
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Myers JS, Shirazipour CH, Wertheimer JC, Asher A. Feasibility Pilot Study of a Virtual Intervention for Survivors With Decreased Perceived Cognitive Function After Cancer Treatment. Oncol Nurs Forum 2022; 49:90-95. [PMID: 34914683 DOI: 10.1188/22.onf.90-95] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Many cancer survivors report issues with cognitive function following diagnosis and treatment. The purpose of this single-arm pilot study was to test the feasibility and acceptability of virtual delivery of a cognitive rehabilitation intervention for participants in virtual groups. SAMPLE & SETTING 37 adult cancer survivors reporting impaired cognitive function following primary treatment were enrolled from Cedars-Sinai Medical Center and affiliates, the University of Kansas Cancer Center, and the Masonic Cancer Alliance. METHODS & VARIABLES Two cohorts attended six weekly virtual sessions and completed pre- and postintervention patient-reported outcome questionnaires designed to measure perceived cognitive function, loneliness, and determinants of behavior change for exercise, sleep, and mindfulness. RESULTS Postintervention scores for perceived cognitive function, determinants of behavior change, and loneliness ratings significantly improved. IMPLICATIONS FOR NURSING Evidence continues to build in support of cognitive rehabilitation interventions for cancer survivors. Nurses play an important role in terms of patient identification, participation, and facilitation.
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36
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Santina T, Beaulieu D, Gagné C, Guillaumie L. Mediators and moderators of physical activity changes in a school-based intervention targeting childhood obesity. J Health Psychol 2021; 27:2671-2684. [PMID: 34881675 DOI: 10.1177/13591053211061407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/17/2022] Open
Abstract
This study identifies mediators and moderators of changes in physical activity (PA) following a school-based pilot intervention. Students from two Lebanese schools were randomly allocated into intervention (n = 191) and control (n = 183) groups. The multiple-mediation analysis revealed that active self-identity and perceived barriers mediated the intervention's effect on PA changes. Baseline intention, attitude, PBC, and age moderated PA changes at post-intervention. The youngest participants and those reporting the lowest PA scores at baseline benefited most from the intervention. Future interventions with students should target these mediators and moderators to promote positive change in PA behavior.
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Abstract
Relationship partners affect one another's health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target's health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner's health and their relationship. In turn, their actions have consequences not only for targets' health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.
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Affiliation(s)
| | | | | | - Keven Joyal-Desmarais
- Concordia University, Montreal, Quebec, Canada.,Montreal Behavioural Medicine Centre, Quebec, Canada
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Abstract
Social isolation and loneliness were already pressing concerns prior to the pandemic, but recent trends suggest a potential broadening of this public health crisis. Social connections have potent influences on health and longevity, and lacking social connection qualifies as a risk factor for premature mortality. However, social factors are often overlooked in medical and healthcare practice. There is also evidence documenting effects on biomarkers and health-relevant behaviors, as well as more proximal means social connection influences physical health. A recent National Academy of Science consensus committee report provides recommendations for how this evidence can inform medical and healthcare. Clinicians play an important role in assessing, preventing, and mitigating the adverse effects of social isolation and loneliness.
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Naseri C, McPhail SM, Morris ME, Haines TP, Etherton-Beer C, Shorr R, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Hill AM. Tailored Education Increased Capability and Motivation for Fall Prevention in Older People After Hospitalization. Front Public Health 2021; 9:683723. [PMID: 34414157 PMCID: PMC8369365 DOI: 10.3389/fpubh.2021.683723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital discharge. Utilizing data gathered from a recent trial, data was analyzed from 390 people who were 60 years and over without impaired cognition (>7/10 abbreviated mental test score) and discharged from three Australian hospitals. Motivation and capability were measured at baseline in the hospital and at 6-months after hospital discharge by blinded assistants using structured surveys. Bivariate analysis using generalized linear modeling explored the impact of education on the capability and motivation. Engagement in fall prevention strategies was entered as an independent variable during analysis to determine associations with capability and motivation. The education significantly improved capability [-0.4, 95% CI (-0.7, -0.2), p < 0.01] and motivation [-0.8, 95% CI (-1.1, -0.5), p < 0.01] compared with social-control at the time of hospital discharge. In contrast, social-control participants gained capability and motivation over the 6-months, and no significant differences were found between groups in capability [0.001, 95% CI (-0.2, 0.2), p = 0.9] and motivation [-0.01, 95% CI (-0.3, 0.3), p = 0.9] at follow-up. Tailored fall prevention education is recommended around hospital discharge. Participants still needed to overcome barriers to falls prevention engagement post hospitalization. Thus, tailored education along with direct clinical services such as physiotherapy and social supports is warranted for older people to avoid falls and regain function following hospitalization.
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Affiliation(s)
- Chiara Naseri
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Meg E Morris
- Healthscope Academic and Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia.,College of Healthcare Sciences, James Cook University, Douglas, QLD, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Christopher Etherton-Beer
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Ronald Shorr
- Malcom Randall Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Gainesville, FL, United States.,College of Medicine, University of Florida, Gainesville, FL, United States
| | - Leon Flicker
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A Lee
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Jacqueline Francis-Coad
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Department of Health, Perth, WA, Australia
| | - Anne-Marie Hill
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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Tomczyk S, Barth S, Schmidt S, Muehlan H. Utilizing Health Behavior Change and Technology Acceptance Models to Predict the Adoption of COVID-19 Contact Tracing Apps: Cross-sectional Survey Study. J Med Internet Res 2021; 23:e25447. [PMID: 33882016 PMCID: PMC8136409 DOI: 10.2196/25447] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/18/2020] [Accepted: 04/11/2021] [Indexed: 01/11/2023] Open
Abstract
Background To combat the global COVID-19 pandemic, contact tracing apps have been discussed as digital health solutions to track infection chains and provide appropriate information. However, observational studies point to low acceptance in most countries, and few studies have yet examined theory-based predictors of app use in the general population to guide health communication efforts. Objective This study utilizes established health behavior change and technology acceptance models to predict adoption intentions and frequency of current app use. Methods We conducted a cross-sectional online survey between May and July 2020 in a German convenience sample (N=349; mean age 35.62 years; n=226, 65.3% female). To inspect the incremental validity of model constructs as well as additional variables (privacy concerns, personalization), hierarchical regression models were applied, controlling for covariates. Results The theory of planned behavior and the unified theory of acceptance and use of technology predicted adoption intentions (R2=56%-63%) and frequency of current app use (R2=33%-37%). A combined model only marginally increased the predictive value by about 5%, but lower privacy concerns and higher threat appraisals (ie, anticipatory anxiety) significantly predicted app use when included as additional variables. Moreover, the impact of perceived usefulness was positive for adoption intentions but negative for frequency of current app use. Conclusions This study identified several theory-based predictors of contact tracing app use. However, few constructs, such as social norms, have a consistent positive effect across models and outcomes. Further research is required to replicate these observations, and to examine the interconnectedness of these constructs and their impact throughout the pandemic. Nevertheless, the findings suggest that promulgating affirmative social norms and positive emotional effects of app use, as well as addressing health concerns, might be promising strategies to foster adoption intentions and app use in the general population.
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Affiliation(s)
- Samuel Tomczyk
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Simon Barth
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Silke Schmidt
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Holger Muehlan
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
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Muralidharan A, Peeples A, Lucksted A. Health Behavior Change Processes Among Adults With Serious Mental Illness Engaged in Illness Self-Management. Qual Health Res 2021; 31:1155-1168. [PMID: 33588639 PMCID: PMC8106668 DOI: 10.1177/1049732321992049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 05/07/2023]
Abstract
Self-management interventions promote illness management among adults with chronic health conditions. Little is known regarding the processes by which these interventions have their effects. The present study examined how Living Well, an effective self-management intervention for adults with serious mental illness, led to health behavior change in a randomized controlled trial. A convenience subset (N = 15) of participants completed qualitative interviews regarding the feasibility/acceptability of Living Well. An inductive secondary qualitative analysis, using a combination of interpretive phenomenological and social constructivist approaches, was conducted to examine processes of change. Results indicate that Living Well provided information and knowledge, opportunities for learning from others and real-world practice, and an interpersonally supportive environment. These active ingredients led to enhanced self-awareness, confidence, sense of control, and behavior and health status changes among participants. These findings are considered in the context of prominent behavior change theories such as social cognitive theory and self-regulation.
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Affiliation(s)
- Anjana Muralidharan
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amanda Peeples
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alicia Lucksted
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
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Oliffe JL, Black N, Yiu J, Flannigan R, Hartrick W, Goldenberg SL. Promoting Men's Health With the "Don't Change Much" e-Program. Am J Mens Health 2021; 15:15579883211001189. [PMID: 33745369 PMCID: PMC7983442 DOI: 10.1177/15579883211001189] [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] [Indexed: 11/15/2022] Open
Abstract
Men's e-health promotion programs can offer end-user anonymity and autonomy that provide avenues for supporting positive health behavior change. The twofold purpose of the current study was to use a benchmark cohort as a reference group to: (1) describe associations between men's usage levels of the e-health program Don't Change Much (DCM) and their recent and intended health behavior changes, and (2) report an exploratory analysis of the moderating effects of demographic variables on the associations between DCM users and their recent and intended health behavior changes. Based on self-report, DCM users were classified into limited (n = 613, 34.7%), low (n = 826, 46.8%), and high (n = 327, 18.5%) exposure groups. Compared with the benchmark cohort, DCM high-exposure respondents had significantly increased odds for eight of the nine recent behavior changes, with the largest effect size observed for "Made an effort to sit less and walk more" (odds ratio [OR] 2.996, 95% CI [2.347, 3.826]). Eight of the nine intended health behavior changes in the DCM high-exposure group had significantly increased odds compared to the benchmark cohort, with "Reduce stress level" (OR 3.428, 95% CI [2.643, 4.447]) having the largest effect size. Significantly greater total numbers of recent (F(12, 2850) = 29.32; p = .001; R2 = .086) and intended health behavior changes (F(12, 2850) = 34.59; p = .001; R2 = 0.100) were observed among high exposure respondents while adjusting for demographics. Younger age, being employed, and household income <$120,000 had an enhancing moderator effect on DCM users' number of intended behavior changes.
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Affiliation(s)
- John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, University of Melbourne, Victoria, Australia
| | - Nick Black
- Intensions Consulting, Vancouver, BC, Canada
| | - Jeffrey Yiu
- Intensions Consulting, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urology, Male Reproduction & Microsurgery, Weill Cornell Medicine, New York, NY, USA.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Canadian Men's Health Foundation, Vancouver, BC, Canada
| | | | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Canadian Men's Health Foundation, Vancouver, BC, Canada
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Yen HY, Huang HY. Comparisons of physical activity and sedentary behavior between owners and non-owners of commercial wearable devices. Perspect Public Health 2021; 141:89-96. [PMID: 33733947 DOI: 10.1177/1757913921989389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
AIMS Wearable devices are a new strategy for promoting physical activity in a free-living condition that utilizes self-monitoring, self-awareness, and self-determination. The main purpose of this study was to explore health benefits of commercial wearable devices by comparing physical activity, sedentary time, sleep quality, and other health outcomes between individuals who used and those that did not use commercial wearable devices. METHODS The research design was a cross-sectional study using an Internet survey in Taiwan. Self-administered questionnaires included the International Physical Activity Questionnaire-Short Form, Pittsburgh Sleep Quality Index, Health-Promoting Lifestyle Profile, and World Health Organization Quality-of-Life Scale. RESULTS In total, 781 participants were recruited, including 50% who were users of wearable devices and 50% non-users in the most recent 3 months. Primary outcomes revealed that wearable device users had significantly higher self-reported walking, moderate physical activity, and total physical activity, and significantly lower sedentary time than non-users. Wearable device users had significantly better sleep quality than non-users. CONCLUSION Wearable devices inspire users' motivation, engagement, and interest in physical activity through habit formation. Wearable devices are recommended to increase physical activity and decrease sedentary behavior for promoting good health.
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Affiliation(s)
- Hsin-Yen Yen
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wuxing St., Taipei 11031, Taiwan
| | - Hao-Yun Huang
- Gold Coast University Hospital, Southport, QLD, Australia
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Vicerra PMM. Knowledge-Behavior Gap on COVID-19 among Older People in Rural Thailand. Gerontol Geriatr Med 2021; 7:2333721421997207. [PMID: 33718521 PMCID: PMC7917830 DOI: 10.1177/2333721421997207] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/29/2022] Open
Abstract
This study analyzed the difference between rural and urban older adults in
Thailand regarding the relationship between the knowledge and behavior toward
the prevention of contracting COVID-19. Path analysis was used to observe if the
performance of protective behaviors was affected by the level of knowledge that
older people have about the disease. This study used the Impact of COVID-19 on
Older Persons in Thailand survey collected across the five regions of the
country. Rural residents benefited from community network of village health volunteers who
provided information during the pandemic but, they had disadvantages on
accessing newer media sources, mainly the internet, for the latest developments
on COVID-19. Rural older adults had a higher level of knowledge about COVID-19
than those in urban areas; no difference was observed regarding their behavior
to prevent themselves from being infected. The knowledge-behavior gap was viewed
as a mechanism of cognitive avoidance because of overwhelming unprecedented
information.
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Meiers SJ, Dyce E, Wieland ML, Patten C, Clark MM, Hanza MMK, Bronars C, Nigon JA, Sia IG. Lay health worker as interventionist training: reflective writing in US family health promotion practice. Health Promot Int 2021; 36:1739-1752. [PMID: 33619566 DOI: 10.1093/heapro/daaa143] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.
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Affiliation(s)
- Sonja J Meiers
- Department of Graduate Nursing, Winona State University, Rochester, MN 55904, USA
| | - Evan Dyce
- Department of Graduate Nursing, Winona State University, Rochester, MN 55904, USA.,Department of Family Medicine, CentraCare, Big Lake, MN 55309, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Rochester, MN 55905, USA
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Carrie Bronars
- Department of Mental Health, Minneapolis Veterans Administration Health Care System, Minneapolis, MN 55417, USA
| | - Julie A Nigon
- Hawthorne Education Center, Rochester Public Schools Rochester, Rochester, MN 55902, USA
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Brosso SN, Sheeran P, Lazard AJ, Muscatell KA. Harnessing Neuroimaging to Reduce Socioeconomic Disparities in Chronic Disease: A Conceptual Framework for Improving Health Messaging. Front Hum Neurosci 2021; 15:576749. [PMID: 33633551 PMCID: PMC7901919 DOI: 10.3389/fnhum.2021.576749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/26/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Socioeconomic status (SES)-related health disparities persist for numerous chronic diseases, with lower-SES individuals exhibiting greater risk of morbidity and mortality compared to their higher-SES counterparts. One likely contributor is disparities in health messaging efforts, which are currently less effective for motivating health behavior change among those lower in SES. Drawing on communication neuroscience and social neuroscience research, we describe a conceptual framework to improve health messaging effectiveness in lower SES communities. The framework is based on evidence that health-message-induced activity in the ventral striatum (VS) and subdivisions of the medial pre-frontal cortex (MPFC) predicts behavior change. Additionally, we draw from social neuroscience work showing that activity in these regions during valuation and the processing of self-related vs. social information, differs as a function of SES. Bringing together these previously disparate lines of work, we argue that health messages emphasizing the benefits to close others (vs. the self) of engaging in behavior change will be more effective among lower SES individuals. We also outline a research agenda based on our framework. Ultimately, we hope that this framework utilizing a “brain-as-predictor” approach generates novel insights about the neural underpinnings of message-induced behavior change among lower SES individuals, and helps to close the gap in SES-based health disparities by harnessing the power of neuroimaging.
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Affiliation(s)
- Samantha N Brosso
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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47
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Potter K, Masteller B, Balzer LB. Examining Obedience Training as a Physical Activity Intervention for Dog Owners: Findings from the Stealth Pet Obedience Training (SPOT) Pilot Study. Int J Environ Res Public Health 2021; 18:902. [PMID: 33494301 PMCID: PMC7908228 DOI: 10.3390/ijerph18030902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
Dog training may strengthen the dog-owner bond, a consistent predictor of dog walking behavior. The Stealth Pet Obedience Training (SPOT) study piloted dog training as a stealth physical activity (PA) intervention. In this study, 41 dog owners who reported dog walking ≤3 days/week were randomized to a six-week basic obedience training class or waitlist control. Participants wore accelerometers and logged dog walking at baseline, 6- and 12-weeks. Changes in PA and dog walking were compared between arms with targeted maximum likelihood estimation. At baseline, participants (39 ± 12 years; females = 85%) walked their dog 1.9 days/week and took 5838 steps/day, on average. At week 6, intervention participants walked their dog 0.7 more days/week and took 480 more steps/day, on average, than at baseline, while control participants walked their dog, on average, 0.6 fewer days/week and took 300 fewer steps/day (difference between arms: 1.3 dog walking days/week; 95% CI = 0.2, 2.5; 780 steps/day, 95% CI = -746, 2307). Changes from baseline were similar at week 12 (difference between arms: 1.7 dog walking days/week; 95% CI = 0.6, 2.9; 1084 steps/day, 95% CI = -203, 2370). Given high rates of dog ownership and low rates of dog walking in the United States, this novel PA promotion strategy warrants further investigation.
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Affiliation(s)
- Katie Potter
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Brittany Masteller
- Department of Exercise & Sport Studies, Smith College, Northampton, MA 01063, USA;
| | - Laura B. Balzer
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA 01003, USA;
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Kramer LL, Mulder BC, van Velsen L, de Vet E. Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e22186. [PMID: 33404513 PMCID: PMC7817356 DOI: 10.2196/22186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/20/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner. OBJECTIVE We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA. METHODS The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome-use-will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview. RESULTS As of July 2020, we have begun recruiting participants. CONCLUSIONS By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context. TRIAL REGISTRATION ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/22186.
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Bob C Mulder
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
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49
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Musgrave LM, Kizirian NV, Homer CSE, Gordon A. Mobile Phone Apps in Australia for Improving Pregnancy Outcomes: Systematic Search on App Stores. JMIR Mhealth Uhealth 2020; 8:e22340. [PMID: 33196454 PMCID: PMC7704277 DOI: 10.2196/22340] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 10/26/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Women are increasingly turning to mobile health platforms to receive health information and support in pregnancy, yet the content of these platforms vary. Although there is great potential to influence health behaviors, little research has assessed the quality of these platforms or their ability to change behavior. In recent years, validated tools to assess app quality have become available. OBJECTIVE To identify and assess the quality and ongoing popularity of the top 10 freely available pregnancy apps in Australia using validated tools. METHODS A systematic search on app stores to identify apps was performed. A Google Play search used subject terms pregnancy, parenting, and childbirth; the iTunes search used alternative categories medical and health and fitness. The top 250 apps from each store were cross-referenced, and the top 100 found in both Google Play and iTunes were screened for eligibility. Apps that provided health information or advice for pregnancy were included. Excluded apps focused on nonhealth information (eg, baby names). The top 10 pregnancy apps were assessed using the Mobile App Rating Scale (MARS). A comparative analysis was conducted at 2 time points over 2 years to assess the ongoing popularity of the apps. The MARS score was compared to the download and star rating data collected from iTunes and Google Play in 2017 and 2019. Health behaviors including breastfeeding, healthy pregnancy weight, and maternal awareness of fetal movements were reviewed for apparent impact on the user's knowledge, attitudes, and behavior change intentions using the MARS perceived impact section and the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy. RESULTS A total of 2052 free apps were screened for eligibility, 1397 were excluded, and 655 were reviewed and scored. The top 10 apps were selected using download numbers and star ratings. All 10 apps were suboptimal in quality, practicality, and functionality. It was not possible to identify a primary purpose for all apps, and there was overlap in purpose for many. The mean overall MARS app quality score across all 10 apps was 3.01 (range 1.97-4.40) in 2017 and 3.40 (range 2.27-4.44) in 2019. A minority of apps scored well for perceived impact on health behavior using the MARS tool. Using the CALO-RE 40 item taxonomy, the number of behavior change techniques used was low. The mean number of behavior change techniques for breastfeeding was 5 (range 2-11), for pregnancy weight was 4 (range 2-12), and for maternal awareness of fetal movements was 5 (range 2-8). CONCLUSIONS This review provides valuable information to clinicians and consumers about the quality of apps currently available for pregnancy in Australia. Consideration is needed regarding the regulation of information and the potential opportunity to incorporate behavior change techniques to improve maternal and fetal outcomes.
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Affiliation(s)
- Loretta M Musgrave
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Ultimo NSW, Australia
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown NSW, Australia
| | - Nathalie V Kizirian
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown NSW, Australia
| | - Caroline S E Homer
- Burnet Institute, Melbourne VIC, Australia
- Centre for Midwifery, Child, and Family Health, University of Technology Sydney, Ultimo NSW, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown NSW, Australia
- Sydney Local Health District, NSW Health, Camperdown NSW, Australia
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50
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Smith SN, Liebrecht CM, Bauer MS, Kilbourne AM. Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res 2020; 55:954-965. [PMID: 33125166 DOI: 10.1111/1475-6773.13583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the comparative effectiveness of external facilitation (EF) vs external + internal facilitation (EF/IF), on uptake of a collaborative chronic care model (CCM) in community practices that were slower to implement under low-level implementation support. STUDY SETTING Primary data were collected from 43 community practices in Michigan and Colorado at baseline and for 12 months following randomization. STUDY DESIGN Sites that failed to meet a pre-established implementation benchmark after six months of low-level implementation support were randomized to add either EF or EF/IF support for up to 12 months. Key outcomes were change in number of patients receiving the CCM and number of patients receiving a clinically significant dose of the CCM. Moderators' analyses further examined whether comparative effectiveness was dependent on prerandomization adoption, number of providers trained or practice size. Facilitation log data were used for exploratory follow-up analyses. DATA COLLECTION Sites reported monthly on number of patients that had received the CCM. Facilitation logs were completed by study EF and site IFs and shared with the study team. PRINCIPAL FINDINGS N = 21 sites were randomized to EF and 22 to EF/IF. Overall, EF/IF practices saw more uptake than EF sites after 12 months (ΔEF/IF-EF = 4.4 patients, 95% CI = 1.87-6.87). Moderators' analyses, however, revealed that it was only sites with no prerandomization uptake of the CCM (nonadopter sites) that saw significantly more benefit from EF/IF (ΔEF/IF-EF = 9.2 patients, 95% CI: 5.72, 12.63). For sites with prerandomization uptake (adopter sites), EF/IF offered no additional benefit (ΔEF/IF-EF = -0.9; 95% CI: -4.40, 2.60). Number of providers trained and practice size were not significant moderators. CONCLUSIONS Although stepping up to the more intensive EF/IF did outperform EF overall, its benefit was limited to sites that failed to deliver any CCM under the low-level strategy. Once one or more providers were delivering the CCM, additional on-site personnel did not appear to add value to the implementation effort.
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Affiliation(s)
- Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Celeste M Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark S Bauer
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
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