A lexicon of assessment and outcome measures for telemental health.

BACKGROUND: The purpose of this document is to provide initial recommendations to telemental health (TMH) professionals for the selection of assessment and outcome measures that best reflect the impacts of mental health treatments delivered via live interactive videoconferencing. MATERIALS AND METHODS: The guidance provided here was created through an expert consensus process and is in the form of a lexicon focused on identified key TMH outcomes. RESULTS: Each lexical item is elucidated by a definition, recommendations for assessment/measurement, and additional commentary on important considerations. The lexicon is not intended as a current literature review of the field, but rather as a resource to foster increased dialogue, critical analysis, and the development of the science of TMH assessment and evaluation. The intent of this lexicon is to better unify the TMH field by providing a resource to researchers, program managers, funders, regulators and others for assessing outcomes. CONCLUSIONS: This document provides overall context for the key aspects of the lexicon.

Challenges, solutions, and best practices in telemental health service delivery across the pacific rim-a summary.

The Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, in conjunction with the American Telemedicine Association's Annual Mid-Year Meeting, conducted a 1-day workshop on how maturing and emerging processes and applications in the field of telemental health (TMH) can be expanded to enhance access to behavioral health services in the Pacific Rim. The purpose of the workshop was to bring together experts in the field of TMH from the military, federal agencies, academia, and regional healthcare organizations serving populations in the Pacific Rim. The workshop reviewed current technologies and systems to better understand their current and potential applications to regional challenges, including the Department of Defense and other federal organizations. The meeting was attended by approximately 100 participants, representing military, government, academia, healthcare centers, and tribal organizations. It was organized into four sessions focusing on the following topic areas: (1) Remote Screening and Assessment; (2) Post-Deployment Adjustment Mental Health Treatment; (3) Suicide Prevention and Management; and (4) Delivery of Training, Education, and Mental Health Work Force Development. The meeting's goal was to discuss challenges, gaps, and collaborative opportunities in this area to enhance existing or create new opportunities for collaborations in the delivery of TMH services to the populations of the Pacific Rim. A set of recommendations for collaboration are presented.

Home-based preventative care in high-risk dialysis patients: a pilot study.

OBJECTIVE: Most dialysis patients have multiple comorbidities with complex healthcare needs and consume a disproportionate share of medical resources. We conducted a pilot study employing telehealth technology to determine whether home-based preventative care can improve healthcare outcomes, impact quality of life (QOL), and be cost effective by proactively managing underlying chronic conditions that place the patient at risk. MATERIALS AND METHODS: Forty-four patients (19 in the remote technology group [RT] and 25 in the usual care group [UC]) participated in this study. The mean age was 57 for those in the RT group (7 females and 12 males) and 62 for those receiving UC (11 females and 14 males). Health outcome measurements included hospitalizations, emergency room visits, and the number of days hospitalized. Economic analysis included total hospital and emergency room charges. QOL was measured using the medical outcomes survey instrument 36-Item Short Form Health Survey (SF-36). RESULTS: Hospitalizations (RT 0.0018 and UC 0.0056 per study day), hospital days (RT 0.008 and UC 0.036 per study day), emergency room visits (RT 0.0003 and UC 0.0019 per study day), and associated charges (RT $114 and UC $322 per study day) were significantly less in the RT group of the study compared with patients receiving UC. The perceived QOL remained the same in the UC group from outset to midpoint of the study (59.1, 59.5), whereas it decreased slightly in the RT group (63.9, 60.76). CONCLUSIONS: The results suggest that remote telehealth technology can play an important role in improving health outcomes and the cost of care of patients with end-stage renal disease who have complex healthcare needs.

Psychophysiological arousal and craving in smokers, deprived smokers, former smokers, and non-smokers.

This study investigates the biometric signature associated with tobacco craving and stress elicitation using principles of cue reactivity. Seventy-five non-smokers and smokers (half of whom were tobacco-deprived for 6 hours) took part in a standardized laboratory session during which they were presented with a series of film clips designed to arouse fear, amusement, or craving. Participants self-reported their emotional response to each film clip and wore non-invasive biosensors to collect physiologic data. Findings indicate different patterns of physiologic arousal for smokers than non-smokers; and that among smokers, deprived smokers had significantly different arousal patterns than non-deprived smokers. This article describes how the elicitation of stress and craving can contribute to the prediction of arousal patterns associated with tobacco craving and how this can create new opportunities for smoking cessation intervention. A comparison of each group's patterns of arousal and physiologic activity is presented, with particular focus on the differences between smokers and deprived smokers.

Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups.

PURPOSE: To examine whether the stages of change of exercise adoption appropriately address strenuous, moderate, and mild intensities of physical activity. DESIGN AND SETTING: Secondary analysis of four data sets investigating transtheoretical model (TTM) constructs for exercise adoption. SUBJECTS: Four samples of differing age groups (adolescents, n = 400; college students, n = 240; adults, n = 346; seniors, n = 504). MEASURES: Stage of change algorithm for exercise adoption and self-reported physical activity. RESULTS: Multivariate analysis of variance (MANOVA) results showed that stages of change were distinguished by strenuous and moderate but not mild exercise in the adolescent, college student, and adult sample. In the senior sample, stage differences were found in the frequency of exercising (equivalent for moderate to strenuous exercise) and the frequency of walking (equivalent for mild exercise). Bivariate correlation coefficients as well as sensitivity, specificity, and related quality indices decreased respectively from strenuous to moderate to mild exercise and from exercising to walking. CONCLUSIONS: Results provide additional support for the construct validity of the stages of change for strenuous and moderate intensities of physical activity. Development of a new stage assessment instrument for mild intensities of physical activity is recommended. Limitations include use of a different validation measure of exercise behavior in the senior sample.

Developing a stage of change measure for assessing recovery from anorexia nervosa.

The purpose of this study was to advance understanding of the self-change process in recovery from anorexia nervosa (AN). This included the development of a measure for assessing readiness to change behaviors and/or cognitions associated with recovery from AN across five stages of change, based on the transtheoretical model of behavior change. Two-hundred and seventy-eight anorexics, predominantly female, completed questionnaires that measured all constructs of the TTM, as well as the EAT-26, demographic items, and other self-reported recovery measures. Based on a quantitative and qualitative comparison of five staging definitions in this relatively large sample of anorexics, it was concluded that the most meaningful staging measure was one that measured progress through the stages by readiness to stop restricting/bingeing/purging behaviors. The development of an algorithm to measure stages of change for recovery from AN has the potential to accelerate clinical research and to augment available treatments in this area.

A computerized, tailored intervention to address behaviors associated with PTSD in veterans: rationale and design of STR(2)IVE.

Combat exposure among military personnel results in increased risk of posttraumatic stress disorder (PTSD), major depression, substance use, and related health risks. PTSD symptoms require innovative approaches to promote effective coping postdeployment. PTSD's nature and scope requires an approach capable of integrating multiple health risks while reaching large populations. This article provides the rationale and approach to adapt and evaluate a Pro-Change computerized tailored intervention (CTI) targeted at behavioral sequelae (i.e., smoking, stress, and depression) for veterans with or at risk for PTSD. The three-phase approach includes: 1) focus groups to review and, subsequently, adapt content of the existing CTI programs; 2) usability testing; and 3) feasibility testing using a three-month pre-postdesign. Effective, theory-based, real-time, multiple behavior interventions targeting veterans' readiness to quit smoking, manage stress, and depression are warranted to provide potential health impact, opportunities for learning veteran-specific issues, and advance multiple health behavior change knowledge.

Military women's attitudes toward menstruation and menstrual suppression in relation to the deployed environment: development and testing of the MWATMS-9 (short form).

PURPOSE: To determine military women's attitudes toward menstruation and menstrual suppression with oral contraceptives in the deployed environment. METHODS: A cross-sectional descriptive design with the administration of the Menstrual Attitude Questionnaire (MAQ) and the 55-item Military Women's Attitudes Towards Menstrual Suppression Scale (MWATMS) to a convenience sample (n = 278) of women in the U.S. Army with deployment experience. FINDINGS: The MAQ's five subscales' mean scores ranged from 3.4 (+/-1.11) to 5.1 (+/-1.06), indicating neutral to moderate attitudes toward menstruation. Measurement development on the MWATMS produced a nine-item scale with three components: stress effects, benefits to self, and environmental barriers. CONCLUSION: Menstrual attitudes were generally neutral in this sample; however, military women favor menstrual suppression during deployment owing to the effects of stress during deployment, benefits that suppression would provide, and the barriers to menstrual hygiene in the deployed environment. Women who perceived menstruation as bothersome and debilitating had positive attitudes toward menstrual suppression. These findings can contribute to appropriate predeployment women's health care and improve the readiness for deployment in female soldiers. Providers should educate women on the risks and benefits of menstrual suppression methods and provide guidance on impact that the deployed environment can have on their menstrual experiences.

Yours, mine, and ours: the importance of scientific collaboration in advancing the field of behavior change research.

The Behavior Change Consortium (BCC) has provided a unique opportunity to combine and explore resources, data, processes, and knowledge as a means of strengthening the validity, reliability, and outcomes that compose the field of behavioral science. The workgroups of the BCC were able to transcend disciplinary boundaries by developing a collaborative framework that fused scholarship and creativity to explore research problems in the area of health behavior change theory and intervention. We have identified seven common elements that emerged from each workgroup and fostered inclusion, progress, and ultimately results. These elements were (a) establishing communication channels, (b) identifying objectives, (c) utilizing common measures, (d) obtaining financial support, (e) seeking outside feedback, (f) engaging "big picture" thinking, and (g) bridging theory to practice. In this article we describe the various processes involved in the creation and sustainability of the BCC, including internal and external communications, leadership, workgroup roles, private and public partnerships, and issues associated with data sharing. We also discuss why, in the case of the BCC, the whole is far greater than the sum of its parts. We present this example of unparalleled multibehavioral research collaboration as a model to other collaborative efforts that will be spawned by the new National Institutes of Health Roadmap initiative.

Measuring tobacco dependence treatment outcomes: a perspective from the behavior change consortium.

The Behavior Change Consortium (BCC) served as a consortium of 15 National Institutes of Health-funded trials intended to link theories of health behavior change to outcomes related to improved diet, exercise, and/or tobacco cessation. Five sites developed and tested interventions aimed at changing tobacco use behaviors, and the remaining 10 focused on changing diet and/or physical activity. The BCC's tobacco dependence workgroup functioned to identify measures of tobacco use and dependence for use across the 15 BCC trials. The BCC tobacco intervention trials described herein were categorized by type of trial; theory(ies) on which each was based; and the "thickness," or intensity, of the intervention. Between-site differences across these parameters posed conceptual and analytic challenges for combining data for cross-site analyses, which were integral to the BCC mission of identifying mechanisms of health behavior change. The lessons learned by the BCC tobacco dependence workgroup regarding the measurement and analysis of tobacco outcomes among BCC trials are discussed, including the challenges and the opportunities regarding the preparation for cross-site analyses. The workgroup concludes that trials should report both assessment of a prolonged period of abstinence of 6 months or longer, in addition to the traditional 7-day point prevalence outcome.

Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium.

Researchers who conduct physical activity (PA) intervention studies provide an invaluable opportunity to further the prevention science knowledge base for implementing and delivering PA programs. Despite recommendations that screening is important to increase patient safety, the specific screening criteria best suited for different community applications are unknown. To add to the limited knowledge base, we examined the screening procedures and the occurrence of adverse events among more than 5,500 participants from 11 diverse PA interventions participating in a trans-National Institutes of Health (NIH) collaborative known as the Behavior Change Consortium (BCC). Numerous adverse events occur in sedentary, chronically ill, or older populations, although few are attributed to activity/exercise interventions. No serious study-related adverse events (SRAEs) were reported across different screening practices, interventions, and/or populations. Relatively few minor SRAEs were reported (primarily musculoskeletal injuries), emphasizing the need to be aware of potential musculoskeletal sequelae during exercise interventions. One common characteristic of these studies is that they recommended "start low and go slow" strategies, with moderate intensity PA as the goal behavior. Recommendations to reframe the meaning and use of screening criteria to initiate PA in the community are discussed. Although we were unable to conduct generalizable quantitative analyses from our data, the combined experience of the BCC studies provides a unique opportunity to examine PA-related screening and safety issues across diverse populations, settings, and intervention programs.