Assuntos
Medicina do Comportamento , Infecções por Coronavirus , Atenção à Saúde , Pandemias , Pediatria , Pneumonia Viral , Telemedicina , Adulto , Medicina do Comportamento/organização & administração , Medicina do Comportamento/normas , COVID-19 , Criança , Infecções por Coronavirus/prevenção & controle , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Humanos , Pandemias/prevenção & controle , Pediatria/organização & administração , Pediatria/normas , Pneumonia Viral/prevenção & controle , Singapura , Telemedicina/organização & administração , Telemedicina/normasAssuntos
Medicina do Comportamento/economia , Medicina do Comportamento/normas , Atenção à Saúde/economia , Atenção à Saúde/normas , Adulto , Instituições de Assistência Ambulatorial , Comportamento Aditivo/economia , Comportamento Aditivo/terapia , Criança , Continuidade da Assistência ao Paciente , Humanos , Transtornos Mentais/economia , Transtornos Mentais/terapia , New JerseyRESUMO
INTRODUCTION: Over the past three decades, a growing research base has emerged around the role of adverse childhood experiences (ACEs) in the biological, psychological, social, and relational health and development of children and adults. More recently, the role of ACEs has been researched with military service members. The purpose of this article was to provide a brief description of ACEs and an overview of the key tenets of the theory of toxic stress as well as a snapshot of ACEs and protective and compensatory experiences (PACEs) research with active duty personnel. METHODS: Ninety-seven active duty personnel completed the study including questions pertaining to demographics, adverse childhood experiences, adult adverse experiences, and PACEs survey. RESULTS: Significant findings pertaining to ACEs and PACEs were found by service member's sex and rank, with higher ACE scores for men and enlisted service members. CONCLUSIONS: The contrast by rank and sex in relation to ACEs punctuates the need for attention to ACEs and protective factors among early career service members in order to promote sustainable careers in the military.
Assuntos
Medicina do Comportamento/estatística & dados numéricos , Militares/psicologia , Adolescente , Adulto , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Estudos Transversais , Feminino , Humanos , Masculino , Militares/estatística & dados numéricos , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Accelerating advances in health behavior change requires releasing the brake, as well as applying the throttle. This paper discusses six challenges or "brakes" that have slowed progress. PURPOSE/METHODS/RESULTS: We engage with six issues that limit investigators' ability to delineate and test the strategy-target and target-behavior relations that underlie effective interventions according to the experimental medicine approach. We discuss the need for guidance on how to identify the relevant mechanism of action (target) in an intervention and whether a periodic table of health behavior constructs might aid investigators. Experimental and correlational analyses (prospective surveys and behavior change techniques) have been used to test the validity of targets, and we present evidence that there is little agreement among the findings from different research designs. Whereas target engagement is typically analyzed in terms of increasing scores on constructs that impel behavior change, we discuss the role of impeding targets and the benefits of adopting a broader construal of potential targets and approaches to engagement. There is presently a paucity of competitive tests regarding which strategies best engage targets and we discuss empirical criteria and conceptual developments that could enhance the evidence base. Finally, we highlight the need to take "context" or conditional intervention effects more seriously by leveraging the interplay between questions about why interventions work and questions about when and for whom they work. CONCLUSION: Candid appraisal of the challenges facing research on health behavior change can generate new opportunities for theoretical development and offer direction and cumulative impetus for empirical work.
Assuntos
Terapia Comportamental , Medicina do Comportamento , Comportamentos Relacionados com a Saúde , Avaliação de Processos em Cuidados de Saúde , Terapia Comportamental/métodos , Terapia Comportamental/normas , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Humanos , Avaliação de Processos em Cuidados de Saúde/métodos , Avaliação de Processos em Cuidados de Saúde/normasRESUMO
Adaptive interventions (AIs) are increasingly popular in the behavioral sciences. An AI is a sequence of decision rules that specify for whom and under what conditions different intervention options should be offered, in order to address the changing needs of individuals as they progress over time. The sequential, multiple assignment, randomized trial (SMART) is a novel trial design that was developed to aid in empirically constructing effective AIs. The sequential randomizations in a SMART often yield multiple AIs that are embedded in the trial by design. Many SMARTs are motivated by scientific questions pertaining to the comparison of such embedded AIs. Existing data analytic methods and sample size planning resources for SMARTs are suitable only for superiority testing, namely for testing whether one embedded AI yields better primary outcomes on average than another. This calls for noninferiority/equivalence testing methods, because AIs are often motivated by the need to deliver support/care in a less costly or less burdensome manner, while still yielding benefits that are equivalent or noninferior to those produced by a more costly/burdensome standard of care. Here, we develop data-analytic methods and sample-size formulas for SMARTs testing the noninferiority or equivalence of one AI over another. Sample size and power considerations are discussed with supporting simulations, and online resources for sample size planning are provided. A simulated data analysis shows how to test noninferiority and equivalence hypotheses with SMART data. For illustration, we use an example from a SMART in the area of health psychology aiming to develop an AI for promoting weight loss among overweight/obese adults. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Assuntos
Psicologia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Promoção da Saúde , Humanos , Sobrepeso/terapia , Psicologia/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Programas de Redução de PesoRESUMO
INTRODUCTION: Burnout in health care, especially among physicians, is a growing concern. It is now well accepted that physician burnout leads to increased depersonalization of patients, lower personal accomplishment, employee turnover, and worse patient outcomes. What is not known, however, is to what extent behavioral health providers (BHPs) in medical settings experience burnout and its associated sequela. METHOD: Participants (n = 230) from a variety of practice settings and levels of integrated care completed practice and burnout questions via an online survey. Practice-related questions and a modified version of the Maslach Burnout Inventory was administered to BHPs who work in different levels of collaboration with other medical providers. RESULTS: Overall, BHPs who work primarily in fully integrated care settings reported higher rates of personal accomplishment in their everyday job (B = 1.49; 95% confidence interval [CI] = 0.40, 2.58). Additionally, those who have worked more than 10 years in these types of settings reported both higher personal accomplishment (B = 1.58; 95% CI = 0.68, 2.49) and lower rates of depersonalization (B = -1.32; 95% CI = -2.28, -0.36). DISCUSSION: In contrast to high rates of burnout among many clinicians in the United States, this is the first study to document relatively low rates of reported burnout among integrated care BHPs. The relationships between lower burnout, working in a fully integrated care practice, and experience as a BHP is important to understand when creating and sustaining team-based primary care jobs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Assuntos
Medicina do Comportamento/normas , Esgotamento Profissional/etiologia , Prestação Integrada de Cuidados de Saúde/normas , Pessoal de Saúde/psicologia , Adaptação Psicológica , Adulto , Medicina do Comportamento/estatística & dados numéricos , Esgotamento Profissional/psicologia , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Resiliência Psicológica , Inquéritos e QuestionáriosRESUMO
CONTEXT: Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions. EVIDENCE ACQUISITION: This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018. EVIDENCE SYNTHESIS: Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%). CONCLUSIONS: Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.
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Medicina do Comportamento/métodos , Comportamentos Relacionados com a Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Telemedicina/métodos , Medicina do Comportamento/instrumentação , Medicina do Comportamento/normas , Promoção da Saúde , Humanos , Aplicativos Móveis , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Reprodutibilidade dos Testes , Projetos de Pesquisa/estatística & dados numéricos , Smartphone , Telemedicina/instrumentação , Envio de Mensagens de TextoAssuntos
Atenção à Saúde/organização & administração , Família/psicologia , Qualidade da Assistência à Saúde/normas , Minorias Sexuais e de Gênero/psicologia , Idoso , Medicina do Comportamento/normas , Geriatras/organização & administração , Humanos , Saúde Mental/normas , Publicações Periódicas como Assunto , Assistência TerminalRESUMO
INTRODUCTION: The purpose of this study was to investigate parents' interest in additional primary care-based resources for their children's behavioral health, including parenting support. METHOD: We surveyed 264 English- or Spanish-speaking parents (80% mothers) of children between the ages of 3 and 11 years as they arrived for an appointment at an urban, pediatric primary care clinic. Measures included demographics, the Pediatric Symptom Checklist (PSC-17) as a parent report of the child's behavioral health, and interest in behavioral resources (e.g., a parenting class, online videos). We used multiple regression to evaluate the predictors of resource interest. RESULTS: Most parents reported interest in behavioral health resources, including many parents not reporting behavioral symptoms high enough to meet criteria for a positive PSC-17. Overall, 82% of parents reported interest in at least 1 resource item; 28% reported interest in all 7 resource items. The resource item with the most interest was online videos and resources (64%). More behavioral health issues (indicated by higher PSC-17 total scores) were positively related to interest in resources; 20% screened positive for behavioral health concerns. DISCUSSION: Parental report of child behavioral health issues was related to greater interest in resources for children's behavioral health; of note, much of the interest came from parents reporting levels of behavioral health concerns that would be scored as negative on the screening tool in practice. These results provide support for efforts to increase parenting and behavioral health resources through primary care, and raise questions about how to best direct resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Assuntos
Medicina do Comportamento/métodos , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Medicina do Comportamento/normas , Medicina do Comportamento/tendências , Feminino , Recursos em Saúde/normas , Recursos em Saúde/provisão & distribuição , Humanos , Masculino , Pediatria/métodos , Pediatria/normas , Pediatria/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/tendências , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
Value-based payment initiatives, such as the Medicare Shared Savings Program (MSSP), offer the possibility of using financial incentives to drive improvements in mental health and substance use outcomes. In the past 2 years, Accountable Care Organizations (ACOs) participating in the MSSP began to publicly report on one behavioral health outcome-Depression Remission at Twelve Months, which may indicate how value-based payment incentives have impacted mental health and substance use, and if reforms are needed. For ACOs that meaningfully reported performance on the depression remission measure in 2017, the median rate of depression remission at 12 months was 8.33%. A recent meta-analysis found that the average rate of spontaneous depression remission at 12 months absent treatment was approximately 53%. Although a number of factors likely explain these results, the current ACO design does not appear to incentivize improved behavioral health outcomes. Four changes in value-based payment incentive design may help to drive better outcomes: (1) making data collection easier, (2) increasing the salience of incentives, (3) building capacity to implement new interventions, and (4) creating safeguards for inappropriate treatment or reporting.
Assuntos
Organizações de Assistência Responsáveis/normas , Medicina do Comportamento/normas , Depressão/terapia , Qualidade da Assistência à Saúde/normas , Seguro de Saúde Baseado em Valor , Organizações de Assistência Responsáveis/métodos , Medicina do Comportamento/métodos , Depressão/psicologia , Humanos , Indução de Remissão/métodosRESUMO
Interest in immersive virtual reality (VR) technologies is burgeoning as the hardware becomes less costly and more accessible to users, including researchers and practitioners. This commentary outlines the field of immersive VR and highlights applications of its use relevant to translational behavioral medicine. We describe the challenges facing VR applications for health and medicine, and how the core strengths of behavioral medicine can advance theory, research, and practice using VR. By highlighting potential uses of immersive VR alongside the challenges facing the field, we hope to inspire researchers to apply robust theories, methods, and frameworks to generate stronger evidence about the feasibility, acceptability, efficacy, and effectiveness of using this technology in translational behavioral medicine.
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Medicina do Comportamento , Pesquisa Translacional Biomédica , Realidade Virtual , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Humanos , Pesquisa Translacional Biomédica/métodos , Pesquisa Translacional Biomédica/normasRESUMO
INTRODUCTION: The disproportionate time required to effectively manage psychosocial concerns is a key barrier to advancing delivery of behavioral care by primary care providers. Improved time efficiency is one potential benefit of the integration of behavioral health consultants (BHCs) into pediatric care, but few studies have systematically studied this outcome. We examined the impact of embedded BHCs on duration of medical encounters in a pediatric primary care clinic. METHOD: We conducted a retrospective matched-pairs analysis of encounters involving behavioral consultations versus encounters for similar patients that did not include a consultation (N = 114) using electronic health record timestamp data. We examined both medical duration (i.e., medical provider services) and total duration (i.e., medical services + behavioral consultation). RESULTS: Patient encounters involving behavioral consultation had a significantly longer (+11.23 min) total duration than matched controls, but significantly shorter (-11.67 min) medical duration. DISCUSSION: The results indicate BHCs may improve primary care provider efficiency for patients with behavioral concerns, a notable finding given the impact of clinical time-constraints on important health care outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Assuntos
Medicina do Comportamento/normas , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/normas , Fatores de Tempo , Medicina do Comportamento/métodos , Medicina do Comportamento/estatística & dados numéricos , Criança , Pré-Escolar , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pediatria/métodos , Pediatria/normas , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fluxo de TrabalhoRESUMO
Introduction Four Virginia communities participated in a community services enhancement pilot to centralize intake and referral for childbearing women eligible for home visiting support through the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program. Methods As an aspect of the study, project-trained intake workers administered behavioral health and psychosocial risk screening (including emotional health, substance use, interpersonal violence, and smoking) during intake eligibility assessment. Participants identified as at-risk were referred for community intervention concurrently with referral to MIECHV services. Results In the study sample (N = 1515), emotional health was identified as the most common single risk factor (n = 326, 21.5%) and clusters of 2 or more behavioral health risks were identified for 223 (14.7%) of women. Among those with two or more behavioral health risks, smoking was significantly related to all other areas of behavioral health risk. Conclusion Findings from this multi-site pilot emphasize concomitant behavioral health and psychosocial risks in childbearing women and reinforce the importance of embedding comprehensive public health interventions in community systems of care.
Assuntos
Medicina do Comportamento/métodos , Medição de Risco/métodos , Adulto , Medicina do Comportamento/normas , Feminino , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Projetos Piloto , Cuidado Pós-Natal/métodos , Psicologia , Psicometria/instrumentação , Psicometria/métodos , Medição de Risco/normas , Fatores de Risco , VirginiaRESUMO
The diversity of behavioral medicine, including investigators' disciplines, health conditions, settings, and intervention approaches, creates challenges for promoting the translation of research to practice and policy. Most papers on research translation focus on one pathway, so there is a need for a model that considers multiple pathways of research translation. The purpose is to propose a model of translating research to practice and policy that is broad enough to apply to many behavioral medicine scenarios and suggests options for behavioral medicine investigators to become engaged in research translation. This is a commentary, with examples drawn from scientific and gray literature. A model is proposed that describes five pathways of research translation: research, practice, business, policy, and public opinion. Target audiences, approaches, communication materials, and examples are suggested for each translation pathway. Resources are available for overcoming barriers to research translation. The main benefit of becoming engaged in research translation is a higher likelihood of health impact from the research. Researchers can choose one or more of the pathways of research translation that are suitable for their situation.
Assuntos
Medicina do Comportamento , Política de Saúde , Pesquisa sobre Serviços de Saúde , Pesquisa Translacional Biomédica , Medicina do Comportamento/organização & administração , Medicina do Comportamento/normas , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/normas , Humanos , Pesquisa Translacional Biomédica/organização & administração , Pesquisa Translacional Biomédica/normasRESUMO
BACKGROUND: "Behaviour that Challenges" is common in people living with dementia, resident in care homes and historically has been treated with anti-psychotics. However, such usage is associated with 1800 potentially avoidable deaths annually in the UK. This study investigated the feasibility of a full clinical trial of a specialist dementia care pharmacist medication review combined with a health psychology intervention for care staff to limit the use of psychotropics. This paper focuses on feasibility; including recruitment and retention, implementation of medication change recommendations and the experiences and expectations of care staff. METHODS: West Midlands care homes and individuals meeting the inclusion criteria (dementia diagnosis; medication for behaviour that challenges), or their personal consultee, were approached for consent. A specialist pharmacist reviewed medication. Care home staff received an educational behaviour change intervention in a three-hour session promoting person-centred care. Primary healthcare staff received a modified version of the training. The primary outcome measure was the Neuropsychiatric Inventory-Nursing Home version at 3 months. Other outcomes included quality of life, cognition, health economics and prescribed medication. A qualitative evaluation explored expectations and experiences of care staff. RESULTS: Five care homes and 34 of 108 eligible residents (31.5%) were recruited, against an original target of 45 residents across 6 care homes. Medication reviews were conducted for 29 study participants (85.3%) and the pharmacist recommended stopping or reviewing medication in 21 cases (72.4%). Of the recommendations made, 57.1% (12 of 21) were implemented, and implementation (discontinuation) took a mean of 98.4 days. In total, 164 care staff received training and 21 were interviewed. Care staff reported a positive experience of the intervention and post intervention adopting a more holistic patient-centred approach. CONCLUSIONS: The intervention contained two elements; staff training and medication review. It was feasible to implement the staff training, and the training appeared to increase the ability and confidence of care staff to manage behaviour that challenges without the need for medication. The medication review would require significant modification for full trial partly related to the relatively limited uptake of the recommendations made, and delay in implementation. TRIAL REGISTRATION: ISRCTN58330068 . Registered 15 October 2017. Retrospectively registered.
Assuntos
Demência/psicologia , Demência/terapia , Reconciliação de Medicamentos/métodos , Assistência Centrada no Paciente/métodos , Assistência Farmacêutica , Idoso , Medicina do Comportamento/métodos , Medicina do Comportamento/normas , Cuidadores/psicologia , Cuidadores/normas , Gerenciamento Clínico , Estudos de Viabilidade , Instituição de Longa Permanência para Idosos/normas , Humanos , Reconciliação de Medicamentos/normas , Casas de Saúde/normas , Assistência Centrada no Paciente/normas , Assistência Farmacêutica/normas , Qualidade da Assistência à Saúde/normas , Qualidade de Vida/psicologia , Estudos Retrospectivos , AutocuidadoRESUMO
INTRODUCTION: Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined. METHOD: Two primary care clinic systems were examined in this study. The first was a primary care clinic predominately serving low-income patients: 100 individuals participated. The second was primary care in the context of military treatment centers: 539 individuals participated. RESULTS: Results show that 61% of the patients in the low-income primary care clinic would not attend a specialty mental health appointment versus 30% in the military population. DISCUSSION: This study suggests that primary care behavioral health is a patient-centered approach to care and reaches populations that otherwise may not receive behavioral health services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Assuntos
Medicina do Comportamento/normas , Preferência do Paciente/psicologia , Pacientes/psicologia , Atenção Primária à Saúde/normas , Adulto , Medicina do Comportamento/métodos , Medicina do Comportamento/estatística & dados numéricos , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Satisfação do Paciente , Pacientes/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Estados UnidosRESUMO
Caffeine, the most widely consumed drug in the world, exerts numerous effects on cardiovascular activity. Thus, it is important and advisable to control for caffeine consumption in studies examining caffeine and/or cardiovascular activity and reactivity. This paper 1) reviews the literature concerning caffeine's effects on cardiovascular parameters; 2) summarizes the widely varying protocols used to control for the drug in extant cardiovascular literature, and 3) provide guidelines for caffeine control procedures to minimize potentially confounding acute and withdrawal effects of the drug. An abstention period equal to the average half-life of the drug is recommended for creation of methodological controls for caffeine. Additional methodological recommendations are described concerning factors that moderate the half-life of caffeine. When feasible, researchers should consider and aim to control for caffeine's acute and extended psychophysiological effects. This understudied issue has fundamental implications for caffeine-related investigations and research in psychophysiology and behavioral medicine.
Assuntos
Medicina do Comportamento/normas , Pesquisa Biomédica/normas , Cafeína/farmacologia , Cardiologia/normas , Sistema Cardiovascular/efeitos dos fármacos , Estimulantes do Sistema Nervoso Central/farmacologia , Psicofisiologia/normas , Cafeína/farmacocinética , Estimulantes do Sistema Nervoso Central/farmacocinética , Humanos , MedicinaRESUMO
Introduction: While combat readiness is a top priority for the U.S. Army, there is concern that behavioral health (BH) return to duty (RTD) practices may under-represent the number of soldiers available for deployment. Profiling, the official administrative process by which medical duty limitations are communicated to commanders, was recently found to be significantly under-reporting BH readiness levels in one Army Division. This is a safety issue in addition to a readiness problem, and underscores the importance of better understanding RTD practices in order to offer solutions. This study sought to categorize the information and tools used by Army BH providers in garrison to make decisions about duty limitations that can affect BH readiness. Materials and Methods: A qualitative approach was used for this study. Fourteen semi-structured interviews and three focus groups were conducted with a diverse convenience sample of Army BH providers in October 2015, resulting in input from 29 practitioners. Results: Through thematic analysis, it was discovered that profile decisions are driven first by safety of the soldier and secondarily by the needs of the unit. To facilitate their clinical decision-making, providers consider an array of data including standardized scales, unit mission, consultation with unit leadership, meetings with other providers, and, when appropriate, discussion with the friends and family of the soldier. Conclusions: If the military is to address the concern of under-reporting behavioral health readiness levels in garrison, it is critical to develop more predictability in treatment planning and reporting, as well as access to necessary data to make these clinical decisions. The interviews and focus groups revealed that while the technical process for initiating a profile does not vary, there is great disparity about the amount and type of information that is taken into consideration when making profile decisions. Categorization of the information that supports RTD decisions can lead to a better understanding of the process and inform leadership about ways to improve the accuracy of BH readiness reporting.
Assuntos
Medicina do Comportamento/métodos , Pessoal de Saúde/psicologia , Retorno ao Trabalho/estatística & dados numéricos , Medicina do Comportamento/normas , Medicina do Comportamento/estatística & dados numéricos , Tomada de Decisões , Atenção à Saúde/métodos , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Grupos Focais/métodos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Militares/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Pesquisa Qualitativa , Retorno ao Trabalho/tendênciasRESUMO
In this commentary, we propose a vision for "practice-based translational behavior change research," which we define as clinical and public health practice-embedded research on the implementation, optimization, and fundamental mechanisms of behavioral interventions. This vision intends to be inclusive of important research elements for behavioral intervention development, testing, and implementation. We discuss important research gaps and conceptual and methodological advances in three key areas along the discovery (development) to delivery (implementation) continuum of evidence-based interventions to improve behavior and health that could help achieve our vision of practice-based translational behavior change research. We expect our proposed vision to be refined and evolve over time. Through highlighting critical gaps that can be addressed by integrating modern theoretical and methodological approaches across disciplines in behavioral medicine, we hope to inspire the development and funding of innovative research on more potent and implementable behavior change interventions for optimal population and individual health.