Spirituality in the Context of Well-being. Evaluation of the Psychometric Properties and Added Value of the Spiritual Attitude and Involvement List Short Form (SAIL-SF)

There is growing evidence that spiritual well-being is positively associated with adaptive coping and health. The Spiritual Attitude and Involvement List (SAIL) was developed to measure a sense of connectedness to oneself, the environment and the transcendent as a universal experience. The aim of the current study was to develop a short form of the SAIL (SAIL-SF). A factor analytic approach was adopted to select the items for the SAIL-SF based on earlier studies among nurses (n = 458) and cancer patients (n = 445). The dimensionality, factor-loadings, internal consistency, construct validity and incremental validity of the final SAIL-SF were then evaluated in a new sample of adults (n = 225) participating in a trial assessing a positive psychology intervention. The first study yielded seven items, each representing one of the dimensions of the original SAIL: meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities. The seven items represented a single meaningful factor in both samples and the factor loadings of the items were adequately high. In the second study, a good fit across the various model indices was found and all items had adequately high factor loadings in a strict unidimensional confirmatory factor model and demonstrated good internal consistency. The SAIL-SF explained 7% of variance in ability to adapt above and beyond emotional, psychological, and social well-being. The current study shows that the SAIL-SF has good psychometric properties, and that spiritual well-being has a unique contribution to the ability to adapt in comparison with other types of well-being.

Attitudes and experiences towards the application of motivational interviewing by podiatrists working with people with diabetes at high-risk of developing foot ulcers: a mixed-methods study

Background

Podiatrists are key professionals in promoting adequate foot self-care for people with diabetes at high-risk of developing foot ulcers. However, merely informing patients about the advantages of foot self-care is insufficient to realise behavioural change. Motivational interviewing (MI) is a promising person-centred communication style that could help to create a working alliance between healthcare providers and patient to improve foot self-care. This study aims to observe and analyse the application of MI in consultations carried out by MI-trained and non-MI-trained podiatrists with their patients, and explore podiatrists’ attitudes and experiences towards MI.

Methods

Eighteen podiatrists (median age: 28.5 years, 10 female and 8 male) followed a three-day basic training in MI and 4 podiatrists (median age: 38.5 years, 4 female) were not trained in MI. To observe and rate the MI-fidelity in daily clinical practice, audio recordings from the MI-trained and non-MI-trained podiatrists were scored with the Motivational Interviewing Treatment Integrity code. Individual, semi-structed, in-depth interviews were conducted with the MI-trained podiatrists to explore their attitudes towards and experiences with MI. These data sources were triangulated to describe the effect of training podiatrists in MI for their clinical practice.

Results

The MI-trained podiatrists scored significantly higher than the non-MI-trained podiatrists on two of four global MI-related communication skills (empathy, p = 0.008 and change talk, p = 0.008), on one of five core MI-adherent behaviours (affirmation, p = 0.041) and on one of the other behaviour counts (simple reflections, p = 0.008). The podiatrists mainly reported their attitudes and experiences regarding partnership and cultivating change talk, during the interviews. In addition, they also mentioned facilitators and barriers to using MI and indicated whether they experienced MI as having added value.

Conclusions

The MI-trained podiatrists used the principles of MI at a solid beginner proficiency level in their clinical practice in comparison to the non-MI-trained podiatrists, who did not reach this level. This achievement is in accordance with the basic MI-training they received. This multi-method study reveals that podiatrists can be effectively trained in applying MI in daily clinical practice.

Trial registration

Netherlands Trial Register NL7710. Registered: 6 May 2019.

The D*Phase-study: study protocol for a pragmatic two-phased, randomised controlled (non-inferiority) trial that addresses treatment non-response and compares cognitive behavioural therapy and short-term psychodynamic supportive psychotherapy for major depression

BACKGROUND

Several evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). The objectives are 1. to investigate if, from a group level perspective, SPSP is not inferior to CBT in the treatment of major depressive disorder, 2. to build a model that may help predict the optimal type of treatment for a specific individual; and 3. to determine whether a change of therapist or a change of therapist and treatment method are effective strategies to deal with non-response. Furthermore (4.), the effect of the therapeutic alliance, treatment integrity and therapist allegiance on treatment outcome will be investigated.

METHOD

In this pragmatic randomised controlled trial, 308 patients with a primary diagnosis of MDD are being recruited from a specialised mental health care institution in the Netherlands. In the first phase, patients are randomised 1:1 to either SPSP or CBT. In case of treatment non-response, a second phase follows in which non-responders from treatment phase one are randomised 1:1:1 to one of three groups: continuing the initial treatment with the same therapist, continuing the initial treatment with another therapist or continuing the other type of treatment with another therapist. In both treatment phases, patients are offered sixteen twice-weekly psychotherapy sessions. The primary outcome is an improvement in depressive symptoms. Process variables, working alliance and depressive symptoms, are frequently measured. Comprehensive assessments take place before the start of the first phase (at baseline), in week one, two and four during the treatment, and directly after the treatment (week eight).

DISCUSSION

While the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for MDD.

TRIAL REGISTRATION

The study was registered on 26 August 2016 with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NL5753), https://www.trialregister.nl/trial/5753.

Psychometric properties of the Rheumatoid Arthritis Disease Activity Index (RADAI) in a cohort of consecutive Dutch patients with RA starting anti-tumour necrosis factor treatment

OBJECTIVES

To examine the psychometric properties of the self-administered Dutch Rheumatoid Arthritis Disease Activity Index (RADAI) and its short form (RADAI-SF) in patients with rheumatoid arthritis starting anti-tumour necrosis factor treatment.

METHOD

Internal consistency was assessed with Cronbach's alpha. A confirmatory factor analysis (CFA) was carried out to test the single-factor structure. Construct validity was examined by correlating RADAI and RADAI-SF scores with Disease Activity Score in 28 joints (DAS28). Internal responsiveness was evaluated with the paired t test and the standardised response mean (SRM). External responsiveness was assessed with receiver operating characteristic analysis and the SRM, using the EULAR response criterion as external criterion. Change scores were correlated with changes in DAS28.

RESULTS

At baseline and after 3 months' treatment, respectively, 191 and 171 patients completed the RADAI. The internal consistency of the RADAI and the RADAI-SF was satisfactory. CFAs confirmed the single-factor structure of both RADAI versions, but the short form provided the best model fit. Moderate correlations were found with the DAS28. SRMs of the RADAI and the RADAI-SF were, respectively, 0.76 and 0.80. Both versions had moderate accuracy to distinguish responders from non-responders. Changes scores were moderately correlated with DAS28 change scores.

CONCLUSIONS

This study showed satisfactory psychometric properties of the Dutch version of the RADAI. Omission of the tender joint count (RADAI-SF) produced comparable results and is justified for research purposes. The tender joint count might be useful as additional clinical information in patient management.

Can we assess baseline pain and global health retrospectively?

OBJECTIVE

To study the agreement between patients' actual baseline assessments of pain and global health before treatment and retrospective assessments collected 2 weeks after treatment.

METHODS

Data were collected in a prospective study of 200 rheumatology outpatients treated with a local corticosteroid injection. At baseline and 2-week follow-up, localized pain and global health were assessed on 100 mm visual analogue scales. The follow-up questionnaire was extended with a retrospective assessment of pain and global health before treatment.

RESULTS

At follow-up patients slightly overestimated the severity of pain and global health before treatment. Actual and retrospective assessments were adequately correlated (pain: r(r(r(s) = 0.73; global health: r(s) = 0.67). Bland-Altman analysis showed that both pain and global health were characterized by high intra-individual variation between actual and retrospective assessments, with the 95% limits of agreement (-37.3 to 32.3 mm for pain and -49.7 to 37.8 mm for global health) far exceeding proposed values for minimal clinically important differences.

CONCLUSION

Over a 2-week interval, patients' retrospective assessments of baseline pain and global health are fairly accurate and adequately correlated with actual baseline scores. At the group level, retrospective assessments can provide acceptable data on baseline pain and global health. The wide variability between actual and retrospective assessments, however, indicates that even over short time intervals there is poor individual agreement between the two methods.