RESUMO
Background: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes. Conclusions: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.
Assuntos
Terapia Comportamental , Autogestão , Telemedicina , Cooperação e Adesão ao Tratamento , Humanos , Autogestão/métodos , Autogestão/psicologia , Autogestão/estatística & dados numéricos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos , Telemedicina/normas , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/psicologia , Terapia Comportamental/métodos , Terapia Comportamental/instrumentação , Terapia Comportamental/estatística & dados numéricos , Terapia Comportamental/normas , Doença Crônica/terapia , Doença Crônica/psicologiaRESUMO
BACKGROUND: The 'scale-up' of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process. METHODS: We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered 'scaled-up' if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial ('pre-scale') in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified ([the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial] × 100) to explore any scale-up 'penalties' in intervention effects. RESULTS: We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up - the most common being mode of delivery. CONCLUSION: The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale. TRIAL REGISTRATION: PROSPERO CRD42020144842 .
Assuntos
Terapia Comportamental/métodos , Exercício Físico , Promoção da Saúde/métodos , Terapia Comportamental/estatística & dados numéricos , Humanos , Comportamento SedentárioRESUMO
BACKGROUND: Children's health and welfare have a special place in research and policy in many countries. One of the most important concerns is the increasing rate of backache in children due to many of behavioral risk factors. The aim of this study was to evaluate the effectiveness of an educational program on promoting back-related behavior as well as knowledge, skills, beliefs, and self-efficacy among fifth grade girls. METHODS: The theory-based back care (T-Bak) study was a school-based randomised controlled trial (RCT) that assessed the effectiveness of developing a back care training program based on the social cognitive theory (SCT). A total of 104 schoolchildren aged 11 ± 1.0 years were assigned to intervention (n = 52) and control (n = 52) groups. The intervention group received six sessions training on proper lifting and carrying techniques, having proper posture during daily activities, and correct backpack wearing techniques with a 1-week interval while the control group received nothing. Then, the two groups were assessed for knowledge, skills, self-efficacy, beliefs, and behavior at four points in time: baseline, immediate, three and six-months post-intervention. The changes of the outcomes investigated using univariate repeated measures analysis of variance. Partial eta squared measure (ηp2) was used to calculate effect sizes. RESULTS: A positive change was found for the intervention group back-related behavior from baseline to immediate post-intervention and follow-ups (F = 78.865, p < 0.001, ηp2 = 0.22). Overall there were 36.4% improvement for knowledge (ηp2 = 0.21), 53.2% for the skills (ηp2 = 0.25), 19.5% for the self-efficacy (ηp2 = 0.11), and 25.6% for the beliefs (ηp2 = 0.14) scores from baseline to 6 months' follow-up assessments among the intervention group (p < 0.001). The results also showed a significant interaction effect between group and time. CONCLUSION: The T-Bak intervention was effective in improving back-related behavior in pupils. It is now available and could be evaluated further in back-care related studies. TRIAL REGISTRATION: Current Controlled Trials IRCT20180528039885N1, 30th Oct 2018, 'Prospectively registered'. https://www.irct.ir/trial/31534.
Assuntos
Dor nas Costas/terapia , Terapia Comportamental/educação , Terapia Comportamental/métodos , Promoção da Saúde/métodos , Educação de Pacientes como Assunto/métodos , Estudantes/estatística & dados numéricos , Dor nas Costas/epidemiologia , Terapia Comportamental/estatística & dados numéricos , Criança , Análise Custo-Benefício , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Instituições AcadêmicasRESUMO
BACKGROUND: Informal caregivers of palliative patients show higher levels of depression and distress compared with the general population. Fegg's (2013) existential behavioural therapy was shortened to two individual 1-h sessions (short-term existential behavioural therapy). AIM: Testing the effectiveness of sEBT on psychological symptoms of informal caregivers in comparison with active control. DESIGN: Randomised controlled trial. SETTING/PARTICIPANTS: Informal caregivers of palliative in-patients. METHODS: The primary outcome was depression; secondary outcomes were anxiety, subjective distress and minor mental disorders, positive and negative affect, satisfaction with life, quality of life and direct health care costs. General linear mixed models allow several measurements per participant and change over time. Reasons for declining the intervention were investigated by Rosenstock's Health Belief Model. RESULTS: Overall inclusion rate was 41.0%. Data of 157 caregivers were available (63.1% females; mean age: 54.6 years, standard deviation (SD): 14.1); 127 participants were included in the main analysis. Participation in sEBT or active control was not significantly associated with post-treatment depression. Outcomes showed prevailingly significant association with time of investigation. Self-efficacy, scepticism of benefit of the intervention, belief of better coping alone and support by family and friends were significant factors in declining participation in the randomised controlled trial. CONCLUSION: Inclusion rate was tripled compared with a previously evaluated longer EBT group intervention. By shortening the intervention, inclusion rate was traded for effectiveness and the intervention could not impact caregivers' psychological state. Early integration of sEBT and combination of individual and group setting and further study of the optimal length for caregiver interventions are suggested.
Assuntos
Terapia Comportamental , Cuidadores , Depressão , Qualidade de Vida , Terapia Comportamental/métodos , Terapia Comportamental/normas , Terapia Comportamental/estatística & dados numéricos , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Angústia Psicológica , TempoRESUMO
OBJECTIVE: The objective of this study is to evaluate current evidence for the effectiveness of distance-based interventions to support smoking cessation (SC) or alcohol moderation (AM) among cancer survivors. Secondary, differences in effectiveness are explored regarding multibehaviour interventions versus single-behaviour interventions targeting SC or AM only. METHODS: A systematic search of PubMed, PsycINFO, Web of Science, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials was conducted. Intervention studies with and without control groups and randomized controlled trials were included. Random effects meta-analyses were conducted for the main outcomes: SC and AM rates at the follow-up closest to 6 months. Using subgroup analyses and meta-regression, effectiveness of single-behaviour versus multibehaviour interventions was evaluated. RESULTS: A total of 17 studies with 3796 participants; nine studies on SC only, eight studies on multibehaviour interventions including an SC or AM module, and no studies on AM only were included. All studies had at least some concerns regarding bias. Distance-based SC interventions led to higher cessation rates than control conditions (10 studies, odds ratio [OR] = 1.56; 95% CI, 1.13-2.15, P = .007). Single-behaviour SC interventions reduced smoking rates compared with baseline (risk difference [RD] = 0.29; 95% CI, 0.19-0.39, P < .0001), but multibehaviour interventions did not (RD = 0.13; 95% CI, -0.05 to 0.31, P = 0.15). There was insufficient evidence that distance-based multibehaviour interventions reduced alcohol use compared with controls (three studies, standardized mean difference [SMD] = 0.12; 95% CI, -0.08 to 0.31, P = .24). CONCLUSIONS: Distance-based SC interventions are effective in supporting SC among cancer survivors. Single-behaviour SC interventions appear more effective than multibehaviour interventions. No evidence was found for the effectiveness of distance-based AM interventions for cancer survivors.
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Consumo de Bebidas Alcoólicas/prevenção & controle , Terapia Comportamental , Sobreviventes de Câncer , Avaliação de Resultados em Cuidados de Saúde , Abandono do Hábito de Fumar , Telemedicina , Adulto , Terapia Comportamental/estatística & dados numéricos , Humanos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricosRESUMO
AIMS: To quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007-2018 at a population level. DESIGN: time series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling. SETTING AND PARTICIPANTS: Data were aggregated from 54 847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England. MEASUREMENTS: The input series were: (1) attempts at smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e-cigarettes, (b) NRT over-the-counter, (c) medication on prescription and (d) face-to-face behavioural support; (3) use of roll-your-own tobacco; (4) prevalence of (a) smoking and (b) non-daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio-economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate. FINDINGS: The licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073-1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011-0.201, P = 0.029) and 0.143% (95% CI = 0.009-0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001-0.092, P = 0.046). Other associations were not statistically significant. CONCLUSION: In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.
Assuntos
Guias como Assunto , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/tendências , Adulto , Terapia Comportamental/estatística & dados numéricos , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Meios de Comunicação de Massa/economia , Modelos Estatísticos , Prevalência , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricosRESUMO
BACKGROUND: Mobile health tools such as text messaging programs can support smoking cessation. However, high rates of disengagement from these tools decrease their effectiveness. OBJECTIVE: The purpose of this study was to identify user characteristics associated with retention in an adult text messaging smoking cessation intervention. METHODS: Adults initiating a quit attempt using the publicly available program SmokefreeTXT between March 6 and June 21, 2016 (n=6215), were included. Data were collected to assess nicotine dependence, frequency of being around other smokers, time of the day for cigarette cravings, extrinsic and intrinsic motivation to quit smoking, confidence in quitting, and long-term intention to be smoke free. Multivariable survival analysis modeling for time to opt out was conducted to identify characteristics associated with opting out over the course of the intervention, adjusting for age, sex, and smoking frequency, reset of the quit date by the user, and the number of days enrolled before initiating the quit attempt. Among those who opted out, multivariable multinomial logistic regression analysis was used to identify predictors of opting out early (within 3 days and between 4 and 7 days into the quit attempt) compared to opting out late (more than 7 days into the quit attempt), adjusting for the same confounders. RESULTS: Survival analyses indicated that younger age, female sex, higher levels of nicotine dependence, lower intention to be smoke free, and enrolling in SmokefreeTXT ≤1 week before initiating the quit attempt were associated with an increased risk of opting out. For example, users who smoked within 5 minutes of waking up were 1.17 times more likely to opt out than those who smoked more than 5 minutes after waking up (95% CI 1.01-1.35). Among users who opted out from SmokefreeTXT, logistic regression modeling indicated that compared to users who were never or rarely around other smokers, those who were sometimes around other smokers had 1.96 times more likely to opt out within the first 3 days of the quit attempt (95% CI 1.18-3.25). In addition, compared to users with high levels of long-term quit intention, users with lower levels of intention had 1.80 times the odds of opting out between 4 and 7 days into the quit attempt (95% CI 1.02-3.18). Users who reset their quit date after initiating a quit attempt were less likely to opt out at either time point compared with those who did not reset their quit date. CONCLUSIONS: Several user characteristics are associated with retention in an adult text messaging smoking cessation program. These results provide guidance on potential characteristics that should be addressed in future text messaging smoking cessation programs. Providing additional support to users with these characteristics may increase retention in text messaging programs and ultimately lead to smoking cessation.
Assuntos
Retenção nos Cuidados/classificação , Abandono do Hábito de Fumar/psicologia , Envio de Mensagens de Texto/normas , Cooperação e Adesão ao Tratamento/psicologia , Adolescente , Adulto , Terapia Comportamental/instrumentação , Terapia Comportamental/métodos , Terapia Comportamental/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Retenção nos Cuidados/estatística & dados numéricos , Fumantes/psicologia , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Envio de Mensagens de Texto/instrumentação , Cooperação e Adesão ao Tratamento/estatística & dados numéricosRESUMO
The current study investigated whether quit success among employees who participated in a smoking cessation intervention at the workplace was associated with social support from, and the smoking behavior of, people in their environment. Tobacco-smoking employees (n = 604) from 61 companies participated in a workplace group smoking cessation program. Participants completed questionnaires assessing social support from, and the smoking behavior of, people in their social environment. They were also tested for biochemically validated continuous abstinence directly after finishing the training and after 12 months. The data were analyzed using mixed-effects logistic regression analyses. Social support from colleagues was positively associated with 12-month quit success (odds ratio (OR) = 1.85, 95% confidence interval (CI) = 1.14-3.00, p = 0.013). Support from a partner was positively associated with short-term quit success (OR = 2.01, 95% CI = 1.23-3.30, p = 0.006). Having a higher proportion of smokers in the social environment was negatively associated with long-term abstinence (OR = 0.81, 95% CI = 0.71-0.92, p = 0.002). Compared to having a non-smoking partner, long-term quit success was negatively associated with having no partner (OR = 0.48, 95% CI = 0.26-0.88, p < 0.019), with having a partner who smokes (OR = 0.40, 95% CI = 0.24-0.66, p < 0.001), and with having a partner who used to smoke (OR = 0.47, 95% CI = 0.26-0.86, p = 0.014). In conclusion, people in a smoker's social environment, particularly colleagues, were strongly associated with quit success. The workplace may, therefore, be a favorable setting for smoking cessation interventions.
Assuntos
Terapia Comportamental/métodos , Influência dos Pares , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Meio Social , Apoio Social , Local de Trabalho/psicologia , Adulto , Terapia Comportamental/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Inquéritos e Questionários , Local de Trabalho/estatística & dados numéricosRESUMO
Health behaviour change is a cornerstone in the management of obesity, and data on health behaviours, intentions and barriers to change would be useful to inform the development of interventions. The aim of this study was to describe these variables in individuals with obesity, and to compare obesity classes. The study obtained data from the Canadian Community Health Survey 2011-2012 including 5614 adults with body mass index (BMI) ≥30 kg m-2 . The majority of participants reported eating four or more fruits and vegetables daily (65.3% [95% confidence interval {CI}: 64.1-66.6]), being a regular drinker (59.6% [95% CI: 58.4-61.0]) and inactive (58.0% [95% CI: 56.7-59.3]). About 84% of participants answered they should do and/or intend to do something in the next year to improve their health, with increasing exercise being the most reported choice (69.2% [95% CI: 67.1-71.5]). Among the 58.0% (95% CI: 55.9-60.2) of participants facing barriers to change, the lack of willpower was the most reported (37.0% [95% CI: 34.2-39.7]). No difference between classes for intention to change and barriers were found. Comorbidities were the most important factor explaining several health behaviours and barriers to change. The vast majority of participants, regardless of the severity of obesity, know they should do and also want to do something to improve their health, but faced a lack of willpower. Thus, the most important thing to consider during an obesity intervention is the lack of motivation to modify health behaviours and beyond BMI, the presence of comorbidities.
Assuntos
Terapia Comportamental/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Obesidade/psicologia , Obesidade/terapia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Canadá , Comorbidade , Dieta , Exercício Físico , Feminino , Frutas , Inquéritos Epidemiológicos , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Motivação , Obesidade/classificação , VerdurasRESUMO
AIMS: To examine factors associated with Quitline and pharmacotherapy utilisation in low socioeconomic status (low-SES) smokers enrolled in a smoking cessation trial. METHODS: Baseline data was used from a large-scale smoking cessation randomised controlled trial (RCT). Logistic regression models were used to examine predictors of treatment utilisation prior to entering the RCT and perceived effectiveness of past and future use. RESULTS: A total of 1047 smokers consented and prior to enrolment 92% had previously tried to quit smoking, 86% had ever used quit support, 83% had used pharmacotherapy at least once and 38% had ever utilised Quitline. For those who had used pharmacotherapies, 71% used NRT, of which 21% had used dual NRT products. In the last 12-months, 27% utilised Quitline and 50% utilised NRT. Ever use of Quitline was negatively associated with self-efficacy to quit (OR: 0.80; 95% CI: 0.68, 0.94 pâ¯<â¯.01) and positively associated with being diagnosed with a mental health condition (OR: 1.50; 95% CI: 1.01, 2.25 pâ¯<â¯.05). Recent use of NRT was positively associated with mental health condition (OR: 1.39; 95% CI: 1.02, 1.90 pâ¯<â¯.05) and negatively associated with alcohol consumption (OR: 0.69; 95% CI: 0.52, 0.92 pâ¯<â¯.01). CONCLUSION: Past use of Quitline and pharmacotherapy treatment was associated with self-efficacy to quit, sociodemographic variables, mental health conditions and alcohol consumption. Community-based strategies that target smoking, mental health and drug and alcohol problems may overcome some of the barriers that prevent low-SES populations from engaging with smoking cessation support.
Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Fumar Tabaco/terapia , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Alcoolismo/complicações , Terapia Comportamental/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Fumantes , Abandono do Hábito de Fumar/métodos , Fatores Socioeconômicos , Desemprego/estatística & dados numéricosRESUMO
Health interventions using real-time sensing technology are characterized by intensive longitudinal data, which has the potential to enable nuanced evaluations of individuals' responses to treatment. Existing analytic tools were not developed to capitalize on this opportunity as they typically focus on first-order findings such as changes in the level and/or slope of outcome variables over different intervention phases. This paper introduces an exploratory, Markov-based empirical transition method that offers a more comprehensive assessment of behavioral responses when intensive longitudinal data are available. The procedure projects a univariate time-series into discrete states and empirically determines the probability of transitioning from one state to another. State transition probabilities are summarized separately in phase-specific transition matrices. Comparing transition matrices illuminates intricate, quantifiable differences in behavior between intervention phases. Statistical significance is estimated via bootstrapping techniques. This paper introduces the methodology via three case studies from a secondhand smoke reduction trial utilizing real-time air particle sensors. Analysis enabled the identification of complex phenomena such as avoidance and escape behavior in response to punitive contingencies for tobacco use. Additionally, the largest changes in behavior dynamics were associated with the introduction of behavioral feedback. The Markov approach's ability to elucidate subtle behavioral details has not typically been feasible with standard methodologies, mainly due to historical limitations associated with infrequent repeated measures. These results suggest that the evaluation of intervention effects in data-intensive single-case designs can be enhanced, providing rich information that can ultimately be used to develop interventions uniquely tailored to specific individuals.
Assuntos
Terapia Comportamental/estatística & dados numéricos , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/prevenção & controle , Ensaios Clínicos como Assunto/estatística & dados numéricos , Biologia Computacional , Sistemas Computacionais/estatística & dados numéricos , Retroalimentação Psicológica , Humanos , Estudos Longitudinais , Cadeias de Markov , Tecnologia de Sensoriamento Remoto/estatística & dados numéricos , Software , Poluição por Fumaça de Tabaco/prevenção & controle , Poluição por Fumaça de Tabaco/estatística & dados numéricosRESUMO
BACKGROUND: Modification of health-related behaviors may improve clinical outcomes after acute myocardial infarction (AMI), but the need for systematic efforts to modify such behaviors and the estimated effect have not been investigated, especially in Asian populations. The aim of the study was to investigate changes in smoking and physical activity after AMI and their associations with death and recurrent revascularization. MethodsâandâResults: Using the Korean National Insurance Health Service database, we included 13,452 patients with AMI in 2011, who were stable until 1.5 years on average after onset. Patients were grouped according to their smoking status and physical activity before and after AMI. After AMI, 44.6% of smokers continued smoking and only 11.0% of inactive patients increased their physical activity to a sufficient level. The 'smoker/smoker' group and 'non-smoker/smoker' group showed higher mortality (hazard ratio (HR): 1.566, 95% confidence interval (CI): 1.192-2.035; HR: 1.785, 95% CI: 1.061-2.815, respectively). On the other hand, the 'active/active' group and 'inactive/active' group showed less mortality (HR: 0.625, 95% CI: 0.460-0.832; HR: 0.681, 95% CI: 0.438-1.009, respectively) and the 'inactive/active' group showed less recurrent revascularization (HR: 0.761, 95% CI: 0.599-0.952). CONCLUSIONS: Smoking cessation and maintaining sufficient physical activity after AMI remain challenging for many Korean patients, and are associated with higher rates of mortality and recurrent revascularization. Systematic nationwide efforts such as cardiac rehabilitation (CR) to change health-related behaviors after AMI are required in Korea.
Assuntos
Terapia Comportamental/estatística & dados numéricos , Infarto do Miocárdio/terapia , Bases de Dados Factuais , Exercício Físico , Feminino , Humanos , Masculino , Mortalidade , Infarto do Miocárdio/reabilitação , Revascularização Miocárdica , República da Coreia , FumarRESUMO
Sustained weight loss and health improvements after bariatric surgery require long-term monitoring and, for a significant minority of patients, postoperative intervention. Unfortunately, many patients demonstrate difficulty engaging in long-term follow-up and treatment due to time restrictions, geographic limitations, and financial burden. Conducting assessments and interventions remotely may help to mitigate these barriers, allowing for greater access to care and improved outcomes. This review will summarize the results of research using remote methods to conduct assessments and implement interventions with patients after bariatric surgery. Benefits and challenges of implementing these approaches will be highlighted, and future directions in this area will be discussed.
Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Terapia Comportamental/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Telemedicina/estatística & dados numéricosRESUMO
BACKGROUND: In the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM. METHODS: This study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits. DISCUSSION: Effective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov number NCT03175159 , registered June 5, 2017.
Assuntos
Terapia Comportamental/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Aconselhamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Terapia Comportamental/métodos , Boston , Estimulantes do Sistema Nervoso Central , Florida , HIV , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Profilaxia Pré-Exposição/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento de Redução do Risco , Assunção de Riscos , Sexo Seguro/psicologia , Aconselhamento Sexual/métodos , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/virologia , Resultado do TratamentoRESUMO
Background: Partial adherence in Internet smoking cessation interventions presents treatment and evaluation challenges. Increasing adherence may improve outcomes. Purpose: To present smoking outcomes from an Internet randomized trial of two strategies to encourage adherence to tobacco dependence treatment components: (i) a social network (SN) strategy to integrate smokers into an online community and (ii) free nicotine replacement therapy (NRT). In addition to intent-to-treat analyses, we used novel statistical methods to distinguish the impact of treatment assignment from treatment utilization. Methods: A total of 5,290 current smokers on a cessation website (WEB) were randomized to WEB, WEB + SN, WEB + NRT, or WEB + SN + NRT. The main outcome was 30-day point prevalence abstinence at 3 and 9 months post-randomization. Adherence measures included self-reported medication use (meds), and website metrics of skills training (sk) and community use (comm). Inverse Probability of Retention Weighting and Inverse Probability of Treatment Weighting jointly addressed dropout and treatment selection. Propensity weights were used to calculate Average Treatment effects on the Treated. Results: Treatment assignment analyses showed no effects on abstinence for either adherence strategy. Abstinence rates were 25.7%-32.2% among participants that used all three treatment components (sk+comm +meds).Treatment utilization analyses revealed that among such participants, sk+comm+meds yielded large percentage point increases in 3-month abstinence rates over sk alone across arms: WEB = 20.6 (95% CI = 10.8, 30.4), WEB + SN = 19.2 (95% CI = 11.1, 27.3), WEB + NRT = 13.1 (95% CI = 4.1, 22.0), and WEB + SN + NRT = 20.0 (95% CI = 12.2, 27.7). Conclusions: Novel propensity weighting approaches can serve as a model for establishing efficacy of Internet interventions and yield important insights about mechanisms. Clinical Trials.gov: NCT01544153.
Assuntos
Terapia Comportamental/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Abandono do Hábito de Fumar/estatística & dados numéricos , Rede Social , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Adulto , Terapia Comportamental/métodos , Terapia Combinada , Humanos , Internet , Modelos Estatísticos , Abandono do Hábito de Fumar/métodosRESUMO
OBJECTIVE: To investigate knowledge, attitudes, and practices of oncologists towards physical activity (PA) in cancer survivors, and the association between oncologists' own PA behavior and PA promotion. METHODS: Oncologists (n = 123) completed a survey based on the Theory of Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, attitudes, intentions, social norm, perceived behavioral control (PBC), and confidence and knowledge of exercise prescription. Structural equation modeling (SEM) evaluated these associations. RESULTS: Less than half of oncologists reported regularly promoting PA to patients (46%), with 20% providing written information and 23% referrals. Only 26% were physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion (comparative fit index (CFI) = 0.905, standardized root mean square residual (SRMR) = 0.040). Social norm was not only the significant pathway to intention but also a significant indirect pathway to PA promotion (p = 0.007). Confidence to promote PA, PBC, and intentions were direct significant pathways to PA promotion (p < 0.05). Exploratory SEM pathways explained 19.6% of the variance of PA behavior, which in turn explained 13.1% social norm, 10.7% attitude, 10.0% confidence to recommend, and 17.8% PA promotion behavior (CFI = 0.921, SRMR = 0.076). Instrumental attitude was a direct significant pathway to PA behavior (p = 0.001). PA behavior was a direct significant pathway to social norms, attitude, confidence to recommend, and PA promotion (p < 0.05). CONCLUSIONS: Oncologists reported a modest ability to promote PA, low PA promotion rates, and limited knowledge of exercise prescription. Patient physical activity promotion may be improved through strategies that increase oncologists' PBC, confidence, and their own personal PA participation.
Assuntos
Sobreviventes de Câncer , Terapia por Exercício , Exercício Físico , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/reabilitação , Oncologistas , Padrões de Prática Médica , Adulto , Idoso , Terapia Comportamental/métodos , Terapia Comportamental/estatística & dados numéricos , Sobreviventes de Câncer/psicologia , Estudos Transversais , Terapia por Exercício/psicologia , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Promoção da Saúde/métodos , Humanos , Internacionalidade , Masculino , Oncologia/métodos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/psicologia , Oncologistas/psicologia , Oncologistas/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To determine the efficacy of the Power Over Pain-Coaching (POP-C) intervention to improve functional status among African American outpatients with cancer pain.â©. SAMPLE & SETTING: 310 African American patients were recruited from an urban comprehensive cancer center. The study took place in the patients' homes.â©. METHODS & VARIABLES: A two-group randomized design with repeated measures was used. Data were analyzed with linear mixed effects regression analysis and structural equation change score models. Variables were pain, pain-related distress, functional status, perceived control over pain, and the following antecedents to control. RESULTS: Functional status was improved in POP-C participants relative to control group participants (p < 0.05). Distress also was differentially decreased (p < 0.05). Pain intensity ratings decreased significantly in all patients (p < 0.05). The largest intervention effects were observed in the living with pain component. â©. IMPLICATIONS FOR NURSING: Perceived control over pain was strongly related to functional status and is amenable to interventions using the POP-C intervention components described in this article.
Assuntos
Terapia Comportamental/métodos , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Dor do Câncer/psicologia , Dor do Câncer/terapia , Manejo da Dor/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/estatística & dados numéricos , Estados UnidosRESUMO
INTRODUCTION: Excessive alcohol use is associated with car crashes, violence, and multiple disease conditions, including fetal alcohol spectrum disorders. The U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen all adults and conduct brief counseling interventions with those who misuse alcohol. The USPSTF prefers use of three screening tools that measure alcohol consumption (Alcohol Use Disorders Identification Test, Alcohol Use Disorders Identification Test-Consumption, and National Institute on Alcohol Abuse and Alcoholism Single Question) because these tools detect the full spectrum of alcohol misuse in adults. This study estimated the prevalence of primary care provider screening practices for alcohol misuse and examined factors associated with using a USPSTF-preferred screening tool. METHODS: In 2016, a cross-sectional analysis was conducted on self-reported 2016 DocStyles data to estimate the prevalence of different screening tools used by 1,506 primary care providers-family practitioners, internists, obstetrician/gynecologists, and nurse practitioners. Adjusted prevalence ratios were calculated using logistic regression to examine the association between provider attributes and use of USPSTF-preferred screening tools. RESULTS: In this study, 96% of providers reported screening patients for alcohol misuse. Among those that screened, 38% used a USPSTF-preferred screening tool. Provider specialty, awareness of USPSTF guidelines, and mode of administering screening tool were associated with using a preferred screening tool. CONCLUSIONS: Although most primary care providers reported screening for alcohol misuse, about two thirds did not use a tool capable of detecting the full spectrum of alcohol misuse. Using suitable screening tools will better identify patients who misuse alcohol and increase the opportunity for appropriate intervention, ultimately helping to reduce the burden from the many conditions associated with excessive alcohol consumption.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/prevenção & controle , Programas de Rastreamento/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adulto , Comitês Consultivos/normas , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Terapia Comportamental/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Prevalência , Serviços Preventivos de Saúde/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Autorrelato/estatística & dados numéricos , Estados UnidosRESUMO
AIMS: Patient selection of weight management treatment option is often guided by a variety of factors. Currently, there is no comprehensive tool to facilitate informed decision-making for patients and clinicians. This article aims to synthesise evidence on the treatment effectiveness, health benefits, risks, and patient experiences of treatment options presently available at the Weight Management Clinic at The Ottawa Hospital (TOH), as a first step towards developing a decision aid. METHODS: Narrative and systematic reviews published in English between 1999 and 2014 were included that focused on one or more of the following weight management treatments in adults aged 18 years and over: roux-en-y gastric bypass (RYGB), sleeve gastrectomy (SG), medically supervised meal replacement, and behavioural or lifestyle intervention. RESULTS: Overall, bariatric surgeries have received the greatest research attention and have been associated not only with greater weight loss and health benefit but also with greater risks, complications, and financial cost. Dietary programmes demonstrated weight loss and health benefits to a lesser extent than with surgery but were associated with lower and shorter-term risks and complications. Behavioural and lifestyle interventions have been studied less yet have shown significant, albeit small, weight loss outcomes alone and in combination with dietary or surgical options; they also appear to be the lowest risk interventions. Patient experiences of weight management options are mixed and not well understood. CONCLUSION: Further research is needed; however, this review identified some general trends related to weight loss outcomes, benefits, risks, and barriers for weight management options that have implications for shared treatment decision-making.
Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Terapia Comportamental/estatística & dados numéricos , Dieta/métodos , Obesidade/terapia , Programas de Redução de Peso/métodos , Programas de Redução de Peso/estatística & dados numéricos , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/economia , Terapia Comportamental/economia , Terapia Comportamental/métodos , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta/economia , Dieta/estatística & dados numéricos , Humanos , Estilo de Vida , Obesidade/complicações , Obesidade/psicologia , Cooperação do Paciente , Satisfação do Paciente , Síndromes da Apneia do Sono/prevenção & controle , Programas de Redução de Peso/economiaRESUMO
OBJECTIVES: To examine the impact, acceptability, practicability and implementation of a training intervention, designed using the Behaviour Change Wheel, on the delivery of very brief advice on physical activity, by nurses to cancer patients. STUDY DESIGN: A mixed methods feasibility study. METHOD: A purposeful sample of nurses (n = 62) were recruited across two delivery arms, face-to-face (n = 55) and online (n = 7). Frequency of delivery of physical activity advice was collected at baseline with follow-up at 12 weeks. The 'capability, opportunity and motivation' of nurses to deliver very brief advice was measured via questionnaire. Semi-structured phone interviews (n = 14) were completed and analyzed thematically. A cost consequence analysis was undertaken. RESULTS: The intervention improved the 'capability, opportunity and motivation' of nurses resulting in a change in knowledge, attitudes and beliefs towards physical activity. The intervention was both acceptable and practical. Face-to-face was the preferred mode of delivery, however there was also value in the online option. The cost of delivery per participant was £33.87 for face-to-face delivery, and £103.83 for online delivery inflated due to low recruitment numbers. A significant improvement was seen in delivery of very brief advice at 12 weeks (Z = -4.39, P ≤ 0.01). CONCLUSION: The intervention is acceptable, practical and improves delivery of very brief advice on physical activity by nurses to cancer patients in the short-term. Both face-to-face and online delivery should be considered.