Feasibility and Acceptance Testing of a Mobile Application Providing Psychosocial Support for Parents of Children and Adolescents With Chronic Pain: Results of a Nonrandomized Trial.

Objective To conduct a single-arm pilot study assessing the feasibility and acceptability of a 30-day parent-focused mindfulness and psychosocial support mobile app intervention for parents of children with chronic pain. Methods Thirty parents completed the intervention, which included a mindfulness curriculum, peer support videos, and written psychoeducational content. Twelve healthcare providers also assessed the app and provided feedback. Feasibility was assessed by server-side documented usage on ≥50% of the days in the intervention period and completion of ≥70% of the mindfulness content. Parent and provider acceptance were assessed by ≥70% of participants rating each acceptance test question as ≥5 on a 7-point Likert scale. Parents completed measures of solicitousness, stress, mindful parenting, and resilience prior to and following the intervention. Results Feasibility results were mixed: parents completed mindfulness content on an average of 11.2 days during the intervention period, slightly under the pre-established criterion. However, parents completed an average of 72.1% of the content, which met feasibility criterion. Acceptance criteria were met for the majority of parent acceptance test questions and all of the provider acceptance test questions. Exploratory analyses of the psychosocial measures revealed significant decreases in parental solicitous behavior and perceived stress, and a significant increase in mindful parenting. Conclusions The current study extends the emerging body of research on mindfulness-based interventions for parents of children with chronic illness and suggests that it may be acceptable to deliver this content through a mobile device. Future research is needed to assess the intervention's efficacy compared to standard of care.

Pediatric Irritable Bowel Syndrome: Perspectives on Pain and Adolescent Social Functioning.

OBJECTIVE: The goal of the study was to describe the experiences of adolescents with irritable bowel syndrome (IBS) from the perspective of adolescents, their parents, and health care providers who treat adolescents who have IBS. DESIGN: The study consisted of semistructured interviews. SETTING: Participants were recruited from multidisciplinary pain clinics. SUBJECTS: Thirty-six people participated in the study: 12 adolescents, 12 parents, and 12 health care providers. RESULTS: Two main themes associated with the impact of IBS on adolescents' social functioning emerged from the qualitative interview data: 1) disconnection from peers and 2) strain on family relationships, with subthemes reflecting the perspectives of adolescents, parents, and health care providers. CONCLUSIONS: Participants in our study described that adolescents with IBS encounter significant peer- and family-related social stress. Helpful interventions may be those that focus on social support from other adolescents with similar conditions, as well as family-based therapeutic interventions.

Ethnic and racial diversity in eating disorder prevention trials.

Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults completed measures of appearance esteem, body image flexibility, appearance comparison, and self-compassion. White participants reported lower body esteem and body image flexibility, and higher appearance comparison compared to Black and Asian participants. Latina participants evidenced higher appearance comparison compared to Black participants. The literature review revealed that while rates of diversity in previous trials vary, the majority of the participants were White. Efforts are needed to increase diversity in prevention trials.

Brief report: Feasibility of a mindfulness and self-compassion based mobile intervention for adolescents.

The aim of the study was to test the feasibility of a mindfulness and self-compassion based program for adolescents, to be delivered though mobile phones. Twenty racially and ethnically diverse US adolescents enrolled in a study to use the app for 30 days, after which they provided satisfaction data and participated in focus groups to describe their experiences and offer suggestions for improving the app. Usage data were also captured. Results indicated that participants used the app on the majority of days over the intervention period, reported finding it helpful for managing stress, and provided suggestions for substantive areas for improvement. These findings suggest that a mobile app may be a feasible way to disseminate a mindfulness and selfcompassion based program widely among adolescents.

Feasibility and acceptability of implementing the Making Friends with Yourself intervention on a college campus.

Objective: To assess the feasibility and acceptability of Making Friends with Yourself (MFY): A Mindful Self-Compassion Program for Teens and Young Adults with a sample of college students. A secondary objective was to explore changes in psychosocial outcomes. Participants: Twenty-five students (23 females; mean age 20.35 years) enrolled in the 8-week intervention. Methods: Feasibility was measured by attendance and retention of participants; acceptability was determined through analysis of focus group data. Psychosocial outcomes were assessed through analyses of pre- and post-intervention measures. Results: The intervention was feasible as 20 students attended at least seven of eight classes, and 21 completed the program. Students found the intervention acceptable and reported significant increases in mindfulness and self-compassion and decreased perceived stress from pre- to post-intervention. However, academic stress increased. Conclusions: MFY may be a feasible and acceptable program to offer to college students. Further piloting in college student populations is recommended.

The Role of Social Media in Providing Support from Friends for Adolescent and Young Adult (AYA) Patients and Survivors of Sarcoma: Perspectives of AYA, Parents, and Providers.

Purpose: The aims of the current study were to better understand, from the perspective of adolescents and young adults (AYAs) with sarcoma, parents, and providers, the friendship support needs of AYAs with bone and soft tissue sarcoma and the role of social media in facilitating social support for AYAs with sarcoma. Methods: Semistructured interviews were conducted with 21 participants. AYA (n = 10) ranged in age from 14 to 23 years (mean 19.3, standard deviation 3.4 years; 50% female). All AYAs reported a current or past diagnosis of sarcoma, except for one patient who had another cancer diagnosis but was receiving treatment through the sarcoma clinic. Five parents of the adolescent participants were interviewed, as well as six health care providers. Data analysis was conducted using theory-driven immersion/crystallization, incorporating the Resilience in Illness Model as a framework to guide interpretation of the data. Results: Four main themes associated with social support from friends and social media were identified: (1) Social media provides a way to feel normal and connected to friends; (2) Social media accentuates the frustration of being left behind; (3) Social media facilitates the need to be understood by peers who have experienced sarcoma, and (4) Social media can lead to despair, and also provide hope for the future. Conclusions: Connecting with peers through social media can play an important role in providing support for AYAs with sarcoma, but it may also amplify feelings of frustration and anxiety. Future work is needed to determine intervention components that can maximize the benefits of social media for social support of AYAs with sarcoma. Clinical Trial Registration number: NCT03130751.

The Role of Compassion and Mindfulness in Building Parental Resilience When Caring for Children With Chronic Conditions: A Conceptual Model.

Compassion- and mindfulness-based interventions (CMBIs) and therapies hold promise to support parent resilience by enabling adaptive stress appraisal and coping, mindful parenting, and perhaps crucially, self-compassion. These contemplative modalities have recently been expanded to parents of children with chronic illness, building on successful applications for adults facing stress, chronic pain, or mental illness, and for healthcare professionals in response to caregiver burnout resulting from their work. The design and adaptation of interventions and therapies require a conceptual model of parent resilience in the context of childhood chronic illness that integrates mindfulness and compassion. The objective of this paper is to propose and describe such a model. First, we review the need for parent support interventions for this population. Second, we introduce a Model of Compassion, Mindfulness, and Resilience in Parental Caregiving. We highlight the mindful parenting approaches, guiding theories for adaptive coping, and family resilience frameworks that informed our model. Third, we describe a case of a parent to illustrate a practical application model. Finally, we outline future directions for intervention development and research to examine the impact of CMBIs on parent resilience.

A Mobile-Based Mindfulness and Social Support Program for Adolescents and Young Adults With Sarcoma: Development and Pilot Testing.

BACKGROUND: Approximately 70,000 adolescents and young adults (AYA) are diagnosed with cancer each year in the United States. Sarcomas carry a particularly high symptom burden and are some of the most common cancers among AYA. Recent work has documented significant levels of unmet needs among AYA with cancer, particularly the need for psychosocial support. Mobile technology may be a cost-effective and efficient way to deliver a psychosocial intervention to AYA with cancer and cancer survivors. OBJECTIVE: The two aims of this study were to (1) develop a pilot version of a mobile-based mindfulness and social support program and (2) evaluate program usage and acceptability. An exploratory aim was to examine change in psychosocial outcomes. METHODS: Thirty-seven AYA with sarcoma or sarcoma survivors, parents, and health care providers participated in the study. Semistructured interviews were conducted with 10 AYA, parents of five of the adolescents, and six health care providers. Themes from the interviews helped to inform the development of a mobile-based mindfulness pilot program and a companion Facebook-based social support group. Twenty AYA consented to participate in a single-arm pre-post evaluation of the program; 17 downloaded the app and joined the Facebook group. Seven of these participants had participated in the semistructured interviews. Six additional health care providers consented to participate in the evaluation stage. RESULTS: On average, participants completed 16.9 of the 28 unique sessions and used the mindfulness app for a mean 10.2 (SD 8.2) days during the 28-day evaluation period. The majority of participants (16/17) engaged in the social group and posted at least one reply to the moderator's prompts. The mean number of responses per person to the moderator of the social group was 15.2 of 31 (49%, range 0%-97%). Both AYA and health care providers responded positively to the Mindfulness for Resilience in Illness program and offered useful recommendations for improvements. Exploratory psychosocial analyses indicated there were no significant differences from pretest to posttest on measures of perceived social support, mindfulness, body image, or psychological functioning. CONCLUSIONS: This study offers preliminary support for the feasibility and acceptability of a mobile-based mindfulness and Facebook-based social support program for AYA with sarcoma. The feedback from AYA and health care providers will assist in creating a fully developed intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03130751; https://clinicaltrials.gov/ct2/show/NCT03130751.

Online psychoeducational support for infertile women: a randomized controlled trial.

BACKGROUND: The study goal was to develop and test the effectiveness of a brief online education and support program for female infertility patients. METHODS: A randomized-controlled trial was conducted. Using a Solomon-four group design, 190 female patients were recruited from three US fertility centers and were randomized into two experimental and two no-treatment control groups. The psychological outcomes assessed included infertility distress, infertility self-efficacy, decisional conflict, marital cohesion and coping style. Program dosage and satisfaction were also assessed at four weeks follow-up. RESULTS: Women exposed to the online program significantly improved in the area of social concerns (P = 0.038) related to infertility distress, and felt more informed about a medical decision with which they were contending (P = 0.037). Trends were observed for decreased global stress(P = 0.10), sexual concerns (P = 0.059), distress related to child-free living (P = 0.063), increased infertility self-efficacy (P = 0.067) and decision making clarity (P = 0.079). A dosage response was observed in the experimental groups for women who spent >60 min online for decreased global stress (P = 0.028) and increased self efficacy (P = 0.024). CONCLUSIONS: This evidence-based eHealth program for women experiencing infertility suggests that a web-based patient education intervention can have beneficial effects in several psychological domains and may be a cost effective resource for fertility practices.

Motivation, self-efficacy, physical activity and nutrition in college students: randomized controlled trial of an internet-based education program.

OBJECTIVE: MyStudentBody.com-Nutrition (MSB-N) is an internet-based nutrition and physical activity education program for college students. METHOD: Students from six universities (N=476) in the U.S. were randomly assigned in the fall of 2005 to one of three groups: MSB-N (Experimental I), MSB-N plus Booster (Experimental II), or an attention placebo control group. RESULTS: Experimental I and II group participants increased their fruit and vegetable intake by .33 and .24 servings, respectively, relative to the control group at post-test. Both experimental groups improved their motivation to change eating behaviors (p<.05) and were also more likely to increase their social support and self-efficacy for dietary change (p's<.05). Experimental groups also improved their attitude toward exercise (p<.05), but no behavioral changes in physical activity were noted. CONCLUSION: MyStudentBody.com-Nutrition is an effective internet-based program that may have wide applicability on college campuses for nutrition education and promoting change in health behaviors.

Psychological impact of infertility.

The inability to conceive children is experienced as a stressful situation by individuals and couples all around the world. The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. Evidence is emerging of an association between stress of fertility treatment and patient drop-out and pregnancy rates. Fortunately, psychological interventions, especially those emphasizing stress management and coping-skills training, have been shown to have beneficial effects for infertility patients. Further research is needed to understand the association between distress and fertility outcome, as well as effective psychosocial interventions.

A multimedia psychosocial support program for couples receiving infertility treatment: a feasibility study.

OBJECTIVE: To develop and test the feasibility of a theory-driven, psychosocial support CD-ROM prototype for couples in infertility treatment. DESIGN: Focus group meetings with reproductive health experts, semistructured interviews with infertility patients, and content analysis of an infertility message board to determine content domains of the CD-ROM. Usability and acceptance testing of prototype CD-ROM based on predetermined feasibility criteria. SETTING: Private offices and fertility centers. PATIENT(S): Expert panel of 5 reproductive health specialists; interviews with 62 individuals with infertility (35 women, 27 men); feasibility study with 12 patients and 12 experts in reproductive medicine and infertility support. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Product usability/acceptance test. RESULT(S): Participant feedback and content analysis informed the development of a prototype patient education CD-ROM that uses audio, video, interactive tasks, and personalized feedback. Over 80% of participants successfully completed usability tasks, and over 90% rated prototype satisfaction as "good" to "excellent." Some areas were noted for improvement in navigation and refinement in delivery of instructions. Results strongly indicate an interest in an infertility multimedia support tool. CONCLUSION(S): Multimedia methods may serve as an effective, innovative psychosocial intervention for infertility patients and overcome barriers of limited local access to educational and support services.

A collaborative approach to nutrition education for college students.

It is well established in the literature that college students have poor eating habits and that many barriers exist to achieving optimal nutrition for this busy population. Little is known about students' perceptions of this problem or suggestions for improving their dietary habits. Similarly, college health professionals need innovative approaches to nutritional education. In an effort to develop an online nutrition resource specifically geared to college students, the authors assessed the availability of Internet-based nutritional information for this population and conducted focus groups with students and health professionals to identify relevant nutrition concerns. They used concept-mapping techniques to conduct a systematic analysis of the qualitative information generated from their focus group participants. Their findings emphasize the need for targeted resources for college students and the importance of using students' suggestions in developing nutrition programs.

Social-cognitive correlates of fruit and vegetable consumption in minority and non-minority youth.

OBJECTIVE: Inadequate fruit and vegetable (FV) consumption signals a need for identifying predictors and correlates of intake, particularly in diverse adolescents. DESIGN: Participants completed an on-line assessment in early 2010. SETTING: Computer classrooms in 4 high schools. PARTICIPANTS: One hundred twenty-two Caucasian and 125 minority (African American and Hispanic) high school students (mean age = 15.3 years, SD = 1.0) with parental consent. Response rate was 89%. VARIABLES MEASURED: Self-efficacy as measured by confidence in goal setting and decision making about healthful eating; perceived benefits and barriers to eating FVs; healthful eating-related social support; body esteem; and FV intake. ANALYSIS: t tests were used to examine group differences, and binary logistic regression analyses were conducted to explore the predictors of 5-A-Day FV consumption. RESULTS: Thirty-four percent of the non-minority group and 28% of the minority group reported eating 5 or more portions of FVs a day (P = .34). Self-efficacy and perceived benefits predicted consumption in minority participants, whereas barriers and social support were significant predictors in the non-minority group. CONCLUSIONS AND IMPLICATIONS: These findings suggest different variables predict consumption for minority and non-minority groups and that self-efficacy is an important variable to consider in dietary change programs for minority adolescents.

BodiMojo: effective Internet-based promotion of positive body image in adolescent girls.

This study tested the efficacy of an Internet-based health promotion program, BodiMojo, designed to promote positive body image in adolescents. Participants were 178 students (mean age 15.2 years, 67.6% ethnic minority) in three public high schools. Intervention groups used BodiMojo for four weekly health class periods, while controls participated in their usual health curriculum. Body image measures were given at baseline, post-intervention, and 3 months. Girls reported decreased body dissatisfaction (p<.05), decreased physical appearance comparison (p<.05), and increased appearance satisfaction (p<.05), relative to controls. Effects were not maintained at 3-month follow-up. No significant differences were found between the intervention and control groups with boys. Moderation analyses suggested positive effects for diverse adolescents as well as those who were overweight or indicated baseline high body dissatisfaction. BodiMojo appears to be modestly effective in decreasing body image concerns among adolescent girls in the short term.

Identifying the educational needs of menopausal women: a feasibility study.

BACKGROUND: The goal of this project was to identify the educational needs of menopausal women and test the feasibility of an online self management program based on social learning theory. METHODS: The four stages included 1) a needs assessment using a) focus groups with 24 women ages 40 to 55 and b) phone interviews with eight health experts; 2) the use of concept mapping methodology for quantifying qualitative data from stage 1 to identify the core programmatic concepts; 3) development of a demonstration program; and 4) a pilot study with 35 women and 9 health experts to assess knowledge gained and program satisfaction. RESULTS: Results show that women desire more information about normalcy of menopause and symptom management and found the program to meet a need for menopausal education otherwise perceived as unavailable. The women significantly increased their menopausal knowledge after brief exposure (t(34) = 3.64; p = .001). CONCLUSION: This project provides support for an online health education program for menopausal women and content ideas for inclusion in women's health education curriculum.

Teaching adolescents about changing bodies: Randomized controlled trial of an Internet puberty education and body dissatisfaction prevention program.

This study tested the efficacy of an Internet-based prevention program, Trouble on the Tightrope: In Search of Skateboard Sam, on pubertal knowledge, body esteem, and self-esteem. One hundred and ninety participants (mean age 11.6 years) were randomized to either an intervention or attention placebo control condition and were assessed at baseline, after three Internet-based sessions, and at 3-month follow-up. Although the primary hypotheses were not supported, exploratory moderator analyses indicated that the intervention was beneficial for select students. Specifically, pubertal status moderated the effects on weight-related body esteem and several domains of self-esteem, resulting in positive effects for participants in the intervention group who had begun puberty. Gender differences were found on self-esteem subscales, indicating more robust effects for girls than boys. Tailored Internet programs based on personal characteristics such as gender and pubertal status may be a fruitful area for future research with adolescents.

Web chatter before and after the Women's Health Initiative results: a content analysis of on-line menopause message boards.

A content analysis was conducted on two on-line menopause message boards over 18 months, before and after the announcement of the Women's Health Initiative (WHI) study results on hormone therapy risks. Messages (N = 785) were coded based on overall context themes and specific content (N = 1132 codes). Results showed that "seeking symptom advice" about physical symptoms represented half (49%) of all codes. More specific content codes reflected inquiries about taking prescription hormone therapies, (HTs) how to cope with the menopausal transition, checking in with community members, and questions related to menopause onset and changes in menstrual patterns. Chi-square tests showed an increase in pharmaceutical advice codings over time on the medical board (p = .057) and a trend on the community board after the WHI (p = .10). Similarly, after the WHI there was an increase in the frequency of codes on the community board related to "Is this menopause?" suggesting a heightened awareness about menopause as a health issue. In conclusion, analyses of on-line message boards provide a rich, economical method to discern the needs of menopausal women, as well as to observe the potential impact of a widely publicized medical event that can inform innovative strategies in health promotion for this target population.

Web-based nutrition education for college students: Is it feasible?

College students have poor nutrition habits and often exhibit at-risk weight control behaviors; yet, health promotion efforts on campuses often target other risk behaviors such as alcohol and tobacco use. The goal of this study was to determine program content and examine the feasibility of a web-based nutrition education program for college students using innovative applications of tailoring, targeting and personalization of information. Comprehensive program planning entailed three phases: focus groups and use of concept mapping methodology, prototype web program development, and feasibility testing of the prototype. Results of concept mapping suggested that students and experts agreed on the relative importance of the major content areas unique to the college audience. A prototype web program, informed by health promotion theories, was developed and evaluated. Students and college health professionals participated in the feasibility evaluation, which included acceptance and usability testing of the prototype. Mean scores were computed for the acceptance ratings that indicated that the prototype web program was not only feasible, but also compelling and relevant for the college audience. In conclusion, a tailored, web-based interactive nutrition program could potentially be used to provide individualized nutrition information to encourage college students to adopt healthy eating behaviors.

Development and validation of the Infertility Self-Efficacy scale.

OBJECTIVE: To develop and validate a scale of perceived self-efficacy for people coping with infertility treatment. DESIGN: Self-efficacy scale development involved: [1] item generation with medical experts in reproductive health; [2] a principal components analysis with varimax rotation to identify underlying item components; [3] test-retest reliability and construct (convergent and discriminant) validity with infertility patients, who were administered the Infertility Self-Efficacy (ISE) scale with other measures; and [4] expert acceptability, as determined by reproductive health professionals. SETTING: Recruitment at a fertility center, a national infertility organization, and medical trials web pages. PATIENT(S): A total of 213 participants (159 women; 54 men) with a diagnosis of infertility in the past 2 years were recruited for the various study phases. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants' infertility self-efficacy was assessed with an online assessment battery using the ISE scale; comparison mental health measures assessed current levels of fertility problem distress, perceived stress, and coping style. Reliability, validity, and component structure of the ISE was assessed. RESULT(S): Measurement development yielded a brief 16-item ISE scale that taps an infertility patient's perception about his or her ability to engage in a set of cognitive, emotional, and behavioral skills related to the medical treatment of infertility. The single component of "cognitive/affect regulation" suggests this core set of skills is relevant to successfully managing the experience of infertility. The ISE correlations with comparison mental health measures were as expected, suggesting good convergent and discriminant validity. CONCLUSION(S): The ISE scale appears to be a reliable and valid measure of an individual's self confidence in areas related to health promotion during infertility treatment. Assessing an infertility patients' self-efficacy with the ISE may be useful in clinical research and as a counseling tool to help guide patients in actively managing their fertility treatment.