Students' Perceptions on the Effectiveness of a Computer-Delivered Alcohol Intervention.

Objective: Social adjustment, including alcohol use, directly affects the success of college students. Due to an increased reliance on computer-delivered alcohol interventions (CDIs) a need has emerged to further investigate alcohol use and web-based interventions. Methods: In-depth focus group interviews were conducted with 51 undergraduate students to elicit information from students on the shared experience of participating in a CDI. Results: Participants identified the influence of gender, culture, parents, and family on alcohol use behavior. A difference in personal factors, previous exposure, and experiences can affect the attitudes, behaviors, and outcomes of a CDI. Conclusion: Multiple approaches geared towards a wide variety of students from different backgrounds and environments are needed to be truly successful in preventing alcohol misuse.

Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Health Care Workers and Administrators in Western Kenya: Protocol for a Multistage Qualitative Study.

BACKGROUND: There has been significant interest in global health in low- and middle-income countries (LMICs) among individuals living in high-income countries (HICs) over the past 30 years. Much of the literature on global health engagements (GHEs) has been presented from the perspective of individuals from high-income countries. Local stakeholders such as health care workers and health care administrators represent critical constituencies for global health activities, yet their perspectives are underrepresented in the literature. The purpose of this study is to examine the experiences of local health care workers and administrators with GHEs in Kenya. We will explore the perceived role GHEs play in preparing the health system to address a public health crisis, as well as their role in pandemic recovery and its aftermath. OBJECTIVE: The aims of this study are to (1) examine how Kenyan health care workers and administrators interpret experiences with GHEs as having advantaged or hindered them and the local health system to provide care during an acute public health crisis and (2) to explore recommendations to reimagine GHEs in a postpandemic Kenya. METHODS: This study will be conducted at a large teaching and referral hospital in western Kenya with a long history of hosting GHEs in support of its tripartite mission of providing care, training, and research. This qualitative study will be conducted in 3 phases. In phase 1, in-depth interviews will be conducted to capture participants' lived experience in relation to their unique understandings of the pandemic, GHEs, and the local health system. In phase 2, group discussions using nominal group techniques will be conducted to determine potential priority areas to reimagine future GHEs. In phase 3, in-depth interviews will be conducted to explore these priority areas in greater detail to explore recommendations for potential strategies, policies, and other actions that might be used to achieve the priorities determined to be of highest importance. RESULTS: The study activities commenced in late summer 2022, with findings to be published in 2023. It is anticipated that the findings from this study will provide insight into the role GHEs play in a local health system in Kenya and provide critical stakeholder and partner input from persons hitherto ignored in the design, implementation, and management of GHEs. CONCLUSIONS: This qualitative study will examine the perspectives of GHEs in relation to the COVID-19 pandemic among Kenyan health care workers and health care administrators in western Kenya using a multistage protocol. Using a combination of in-depth interviews and nominal group techniques, this study aims to shed light on the roles global health activities are perceived to play in preparing health care professionals and the health system to address an acute public health crisis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41836.

Development of the Teaching Interpersonal Skills for Telehealth Checklist.

While interpersonal skills in telehealth may positively impact clinical practice, patient engagement and outcomes, assessment strategies are lacking. We conducted a multi-stage iterative approach to develop and test validity and reliability of the Teaching Interpersonal Skills in Telehealth checklist (TIPS-TC). First, we identified observable communication behaviors from the literature. Second, we surveyed telehealth managers and researchers (N = 11) to rate appropriateness of potential checklist items. Level of agreement (35%-91%) and Kappa statistic (0.18-0.89) confirmed items to be retained and identified items to modify. Based on response patterns and comments, we reduced 44 items to 12 critical checklist behaviors. Third, student clinicians used the checklist with video telehealth consultations and provided feedback. Fourth, we conducted reliability testing with practitioners and administrators (N = 68) who completed the TIPS-TC for two versions of a telehealth scenario. Strong interrater reliability intraclass correlation coefficient (ICC) and test-retest reliability ICC (both p < .001), along with non-significant findings of order effects supported the checklist as an acceptable instrument to differentiate high skill from low skill telehealth sessions. The TIPS-TC offers an evidence-based approach to assessing interpersonal skills in telehealth to help evaluate clinician competence and tailor learning activities across disciplinary roles.

Managing Complexity in Evidence Analysis: A Worked Example in Pediatric Weight Management.

Nutrition interventions are often complex and multicomponent. Typical approaches to meta-analyses that focus on individual causal relationships to provide guideline recommendations are not sufficient to capture this complexity. The objective of this study is to describe the method of meta-analysis used for the Pediatric Weight Management (PWM) Guidelines update and provide a worked example that can be applied in other areas of dietetics practice. The effects of PWM interventions were examined for body mass index (BMI), body mass index z-score (BMIZ), and waist circumference at four different time periods. For intervention-level effects, intervention types were identified empirically using multiple correspondence analysis paired with cluster analysis. Pooled effects of identified types were examined using random effects meta-analysis models. Differences in effects among types were examined using meta-regression. Context-level effects are examined using qualitative comparative analysis. Three distinct types (or families) of PWM interventions were identified: medical nutrition, behavioral, and missing components. Medical nutrition and behavioral types showed statistically significant improvements in BMIZ across all time points. Results were less consistent for BMI and waist circumference, although four distinct patterns of weight status change were identified. These varied by intervention type as well as outcome measure. Meta-regression indicated statistically significant differences between the medical nutrition and behavioral types vs the missing component type for both BMIZ and BMI, although the pattern varied by time period and intervention type. Qualitative comparative analysis identified distinct configurations of context characteristics at each time point that were consistent with positive outcomes among the intervention types. Although analysis of individual causal relationships is invaluable, this approach is inadequate to capture the complexity of dietetics practice. An alternative approach that integrates intervention-level with context-level meta-analyses may provide deeper understanding in the development of practice guidelines.

Clinician behaviors in telehealth care delivery: a systematic review.

Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.

Patients' views of teamwork in the emergency department offer insights about team performance.

BACKGROUND: Research into efforts to engage patients in the assessment of health-care teams is limited. OBJECTIVE: To explore, through qualitative methods, patient awareness of teamwork-related behaviours observed during an emergency department (ED) visit. DESIGN: Researchers used semi-structured question guides for audio-recorded interviews and analysed their verbatim transcripts. SETTING AND PARTICIPANTS: Researchers conducted individual phone interviews with 6 teamwork subject matter experts (SMEs) and held 5 face-to-face group interviews with patients and caregivers (n = 25) about 2 weeks after discharge from the emergency department (ED). RESULTS: SMEs suggested that a range of factors influence patient perspectives of teams. Many patients perceived the health-care team within the context of their expectations of an ED visit and their treatment plan. Four themes emerged: (i) patient-centred views highlight gaps in coordination and communication; (ii) team processes do concern patients; (iii) patients are critical observers of ways that team members present their team roles; (iv) patients' observations of team members relate to patients' views of team effectiveness. Analysis also indicated that patients viewed health-care team members' interactions with each other as proxy for how team members actually felt about patients. DISCUSSION: Results from both sets of interviews (SME and patient) indicated that patient observations of teamwork could add to assessment of team processes/frameworks. Patients' understanding about teamwork organization seemed helpful and witnessed interteam communication appeared to influence patient confidence in the team. CONCLUSION: Patients perspectives are an important part of assessment in health care and suggest potential areas for improvement through team training.

Testing of the Patients' Insights and Views of Teamwork (PIVOT) Survey: a validity study.

OBJECTIVE: To explore patient observations of teamwork-related behaviors such as inter-team communication through a newly designed survey. METHODS: In this cross-sectional study, 101 patients (N=86) and caregivers (N=15) recruited from the emergency department (ED) of an urban, academic medical center (>85,000 visits/year) completed the 16-item Patients' Insights and Views Observing Teams (PIVOT) Survey. We evaluated validity evidence through descriptive statistics and analysis including a Many-facet Rasch model to determine associations between questionnaire items and sociodemographic characteristics. RESULTS: Participant responses provided evidence survey items performed well and reflected patients' awareness of team behaviors such as inter-team communication, coordination, and keeping teammates informed. Also, participants responded about the consistency of information from team members and knowing what people's jobs were on the team. Rasch analysis largely supported that the PIVOT items reflected the intended content area and adequacy of ratings scales supporting evidence of response processes. High internal consistency (Cronbach alpha, r=.87) supported evidence of internal structure. As expected, response patterns differed by ED visit acuity level and length of stay. CONCLUSIONS: The PIVOT survey offered a means to collect patient and caregiver observations of health care teams. PRACTICE IMPLICATIONS: PIVOT survey responses may contribute to evaluation of teamwork behaviors.

Psychometric assessment of the Behavior and Attitudes Questionnaire for Healthy Habits: measuring parents' views on food and physical activity.

OBJECTIVE: To assess parents' perspectives of their home environments to establish the validity of scores from the Behavior and Attitudes Questionnaire for Healthy Habits (BAQ-HH). DESIGN: In the present descriptive study, we surveyed a cross-sectional sample of parents of pre-school children. Questionnaire items developed in an iterative process with community-based programming addressed parents' knowledge/awareness, attitudes/concerns and behaviours about healthy foods and physical activity habits with 6-point rating scales. Exploratory and confirmatory factor analyses were used to psychometrically evaluate scores from the scales. SETTING: English and Spanish versions of the BAQ-HH were administered at parent-teacher conferences for pre-school children at ten Head Start centres across a five-county agency in autumn 2010. SUBJECTS: From 672 families with pre-school children, 532 parents provided responses to the BAQ-HH (79 % response rate). The majority was female (83 %), Hispanic (66 %) or white (16 %), and ages ranged from 20 to 39 years (85 %). RESULTS: Exploratory and confirmatory analyses revealed a knowledge scale (seven items), an attitude scale (four items) and three behaviour subscales (three items each). Correlations were identified between parents' perceptions of home activities and reports of children's habits. Differences were identified by gender and ethnicity groupings. CONCLUSIONS: As a first step in psychometric testing, the dimensionality of each of the three scales (Knowledge, Attitudes and Behaviours) was identified and scale scores were related to other indicators of child behaviours and parents' demographic characteristics. This questionnaire offers a method to measure parents' views to inform planning and monitoring of obesity-prevention education programmes.

Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders.

It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling by a registered dietitian (RD), is an essential component of team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders (EDs) during assessment and treatment across the continuum of care. Diagnostic criteria for EDs provide important guidelines for identification and treatment. In addition, individuals may experience disordered eating that extends along a range from food restriction to partial conditions to diagnosed EDs. Understanding the roles and responsibilities of RDs is critical to the effective care of individuals with EDs. The complexities of EDs, such as epidemiologic factors, treatment guidelines, special populations, and emerging trends highlight the nature of EDs, which require a collaborative approach by an interdisciplinary team of mental health, nutrition, and medical specialists. RDs are integral members of treatment teams and are uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. However, this role requires understanding of the psychologic and neurobiologic aspects of EDs. Advanced training is needed to work effectively with this population. Further efforts with evidenced-based research must continue for improved treatment outcomes related to EDs, along with identification of effective primary and secondary interventions. This paper supports the "Practice Paper of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders" published online at www.eatright.org/positions.

Evaluation of the FOCUS (Feedback on Counseling Using Simulation) instrument for assessment of client-centered nutrition counseling behaviors.

OBJECTIVE: To develop an instrument to assess client-centered counseling behaviors (skills) of student-counselors in a standardized patient (SP) exercise. METHODS: Descriptive study of the accuracy and utility of a newly developed counseling evaluation instrument. Study participants included 11 female student-counselors at a Midwestern university-10 Caucasian, 1 African-American-for the simulated counseling sessions, in which the Feedback on Counseling Using Simulation (FOCUS) instrument was applied in 2 SP scenarios (cardiovascular disease and diabetes). FOCUS ratings of student-counselors by 4 SPs during 22 sessions were compared with ratings from a 3-member panel of experts who independently viewed the 22 videotaped sessions. Quantitative analysis of instrument validity included inter-rater reliability by computing generalizability coefficients, Pearson correlations, and Spearman rank-order correlations. RESULTS: FOCUS criteria encompassed relevant dimensions of nutrition counseling based in a client-centered perspective. The critical points of information gathering and counseling behaviors showed internal consistency overall and good inter-rater reliability with the cardiovascular disease scenario. For both scenarios, pooled ratings of 3 experts agreed with ratings carried out by SPs. CONCLUSIONS AND IMPLICATIONS: Initial findings suggest that the FOCUS instrument with client-centered criteria may enhance evaluation of counseling skills in SP exercises, meriting further study with larger groups.

Interorganizational collaboration for health care between nongovernmental organizations (NGOs) in Pakistan.

The complexity and cost of health systems requires innovative forms of organization to provide accessible health services of an acceptable quality and at an acceptable cost. Interorganizational collaboration (IoC) is an innovation to increase the availability of organizational resources, improve service effectiveness, and improve access to health care. In Pakistan, a weak health system and little collaboration limit access, especially of women and children, to health services. Many nongovernmental organizations (NGOs) provide primary health care to the very poor, and some appear to collaborate to varying degrees; however, this has not been systematically analyzed. The purpose of this qualitative research, the first scientific study of collaboration between NGOs providing health services in Pakistan, was to describe collaboration between three pairs of NGOs providing community-based health services to women in Karachi. A long-term goal is to build a basis for future research linking IoC to access to health care and health outcomes. Findings indicated that collaboration was strongest when there was willingness to cooperate, a need for expertise and funds, and adaptive efficiency. In Pakistan's complex social environment, collaboration tended to be stronger when there was fairly high organizational formalization. Broader IoC appears to be positively associated with women's access to health care. Recommendations are made for future research, education, and management.

Health education for nurses in Japan to combat child abuse.

A health education program for nurses was conducted to address the complex problem of child abuse, which has reached epidemic proportions. In Japan, the number of consultations has risen 23-fold over the past 11 years. Maltreatment of children is a public health problem as perilous as any contagious disease. The International Council of Nurses asks for nurses' leadership to strengthen measures to combat abuse throughout the world. The Japanese Nursing Association has published statements for prevention, detection and support. Yet, few community-based education programs with a multidisciplinary perspective have been reported that focus on nurses, the largest group of health providers. More than 200 nurse educators, clinicians and managers met for a one-day program designed to improve understanding of the nurses' role in combatting the abuse and neglect of children and to formulate action plans. This significant health problem is addressed in the context of a health education program's needs, objectives, content and evaluation.