Assessing REflective simulation-based e-Training on motivational interviewing among multidisciplinary healthcare practitioners [RESeT-MI]: a mixed methods pilot study.

BACKGROUND: Many health science curricula have integrated behavioral modification techniques in their plans. Motivational Interviewing is one such technique. Educational interventions to promote Motivational Interviewing have had limited success. Integrating simulation-based learning in health science curricula might offer a platform whereby students can train in well controlled environments with increased authenticity, provision of standardized experiences and the capacity for immediate feedback to participants. Using motivational interviewing as an exemplar, the purpose of this study was to assess the impact of a simulation-based reflective e-training program on knowledge, attitudes, and confidence in Motivational Interviewing among healthcare practitioners from diverse healthcare disciplines. A secondary aim was to explore whether self-reflection can promote reflective learning. METHODS: This was a mixed-method study design. Fifteen participants from different health disciplines were included in the quantitative phase of the study, the simulated interview, and the reflective assignments while five participated in the focus group. Pre and post tests were used to examine the effect of training on knowledge, attitudes, and confidence in Motivational Interviewing. Assessment of Motivational Interviewing Treatment Integrity [MITI] scores in a simulation-based scenario was used. A qualitative content analysis of a focus group provided a more in-depth understanding of the participants experiences. Excerpts from reflective assignments were analyzed using Transformative Learning Theory concepts. RESULTS: A Wilcoxon test showed that the training elicited a change in confidence in performing Motivational Interviewing [Z= -2.766, p = 0.006], median scores increased from 29 to 34. A quarter of technical scores and half of the relational scores indicated good competence. Participants reflected content transformation through feelings of empowerment and satisfaction when they were successful in engaging and motivating clients. Process transformation was evident in reflections on how to improve core skills specifically reflective listening. Reflections on Motivational Interviewing spirit related values showed premise transformation, which may indicate attitude changes. CONCLUSION: A simulation-based e-training program on Motivational Interviewing represents an important educational modality for training in the health disciplines. Results of this study provide evidence supporting the integration of reflective simulation-based e-training into the education curricula of health disciplines in MI and beyond.

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

INTRODUCTION: E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. METHODS: Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). RESULTS: E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (ß=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (ß= -0.32; 95% CI: -0.55 - -0.09) and POS (ß= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (ß=0.35; 95% CI: 0.14-0.56) and POS (ß=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (ß= -0.23; 95% CI: -0.42 - -0.03). CONCLUSIONS: Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

The inclusion of e-cigarettes and heated tobacco products in smoke-free home and car rules: A cross-sectional survey of adults in Armenia and Georgia.

INTRODUCTION: Understanding who includes e-cigarettes and heated tobacco products (HTPs) in smoke-free home or car rules could inform public health interventions, particularly in countries with high smoking prevalence and recently implemented national smoke-free laws, like Armenia and Georgia. METHODS: In 2022, we conducted a cross-sectional survey among 1468 adults in 28 Armenian and Georgian communities (mean age=42.92 years; 51.4% female, 31.6% past-month smoking). Multilevel regression (accounting for clustering within communities; adjusted for sociodemographics and cigarette use) examined e-cigarette/HTP perceptions (risk, social acceptability) and use intentions in relation to: 1) including e-cigarettes/HTPs in home and car rules among participants with home and car rules, respectively (logistic regressions); and 2) intention to include e-cigarettes/HTPs in home rules (linear regression, 1 = 'not at all' to 7 = 'extremely') among those without home rules. RESULTS: Overall, 72.9% (n=1070) had home rules, 86.5% of whom included e-cigarettes/HTPs; 33.9% (n=498) had car rules, 81.3% of whom included e-cigarettes/HTPs. Greater perceived e-cigarette/HTP risk was associated with including e-cigarettes/HTPs in home rules (AOR=1.28; 95% CI: 1.08-1.50) and car rules (AOR=1.46; 95% CI: 1.14-1.87) and next-year intentions to include e-cigarettes/HTPs in home rules (ß=0.38; 95% CI: 0.25-0.50). Lower e-cigarette/HTP use intentions were associated with including e-cigarettes/HTPs in home rules (AOR=0.75; 95% CI: 0.63-0.88). While perceived social acceptability was unassociated with the outcomes, other social influences were: having children and no other household smokers was associated with including e-cigarettes/HTPs in car rules, and having children was associated with intent to include e-cigarettes/HTPs in home rules. CONCLUSIONS: Interventions to address gaps in home and car rules might target e-cigarette/HTP risk perceptions.

Factors associated with support for social enforcement of smoke-free policies in Georgia and Armenia.

INTRODUCTION: Armenia's and Georgia's high rates of smoking and secondhand smoke and recent implementation of smoke-free laws provide a timely opportunity to examine factors that increase compliance, like social enforcement and support for governmental enforcement. METHODS: Using 2022 data from 1468 Armenian and Georgian adults (mean age=42.92 years, 48.6% male, 31.6% past-month smoking), multilevel linear regression examined tobacco-related media exposures, social exposures, and perceptions/attitudes in relation to: 1) likelihood of asking someone to extinguish cigarettes where a) prohibited and b) allowed; and 2) support of fines for smoke-free violations (1=not at all to 4=very). RESULTS: There was low average likelihood of asking someone to extinguish cigarettes where allowed (mean=1.01, SD=1.12) or prohibited (mean=1.57, SD=1.21) and 'little' agreement with fines for smoke-free violations (mean=2.13, SD=1.06). Having fewer friends who smoked, greater support for indoor smoke-free laws, and no past-month cigarette use were positively associated with all 3 outcomes. Greater exposure to media and community-based action supporting smoke-free policies, and witnessing more requests to stop smoking where prohibited, were associated with higher likelihood of asking someone to extinguish cigarettes where allowed or prohibited. Less exposure to news stories opposing smoke-free policies and cigarette ads and higher perceived harm of cigarettes were also related to higher likelihood of asking someone to stop smoking where prohibited. Higher perceived harm of cigarettes was also associated with greater agreement with fines for smoke-free violations. CONCLUSIONS: Comprehensive strategies targeting social norms, media exposure, and risk perceptions are needed to effectively facilitate strategies to enhance smoke-free law enforcement.

Adolescent well-being: A concept analysis.

Although there is a vast literature on the concept of well-being, there appears to be no consensus regarding its meaning. A clear conceptualization of adolescent well-being is necessary as the foundation for interventions and research addressing this phenomenon. Adolescence is a transitional period characterized by rapid growth, gaining independence, and learning social skills as well as behaviours that lay the foundations for future well-being. Therefore, the purpose of this paper was to analyse the concept of adolescent well-being and identify its attributes, antecedents, and empirical referents based on the literature. The Walker and Avant (2019) method was used. Ninety-four articles were included in the final review. The defining attributes of adolescent well-being were identified as autonomy, connectedness, optimism and competency. The antecedents were grouped under internal and external factors. Internal factors included the behavioural, physical, psychological, and spiritual domains. External factors included the environmental, economic, education, leisure, social, and safety as well as security domains. For the adolescent to reach well-being, all these domains must be present, albeit, the social domain was highly stressed. The consequences of adolescent well-being included eudaimonia, having high resilience as well as low risk-taking behaviours and delinquency. Empirical referents were discussed in terms of ways of measuring the defining attributes. Stemming from the eudaimonic perspective, to promote adolescent well-being, care providers need to integrate in education, practice, and research the importance of establishing positive relations and connectedness, to enhance adolescent autonomy and optimism and assist them to grow into competent and self-fulfilled beings.

Primary Care Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Lebanon: A National Cross-sectional Study.

INTRODUCTION: Substance use among adolescents is on the rise globally. Adolescents rarely seek help for problematic substance use and healthcare professionals can easily fail to identify adolescents with risky substance use. There is therefore a significant global need for substance use screening by healthcare professionals followed by appropriate intervention. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that enables clinicians to determine adolescents' risk for substance use and intervene accordingly. However, little effort has been placed on empowering primary care clinicians to use it in Lebanon. We explored the attitudes, perceptions, and practices of primary care nurses and physicians regarding adolescent SBIRT use. METHODS: The study used a cross-sectional multisite survey design targeting urban and rural areas in Lebanon. A national sample of 140 physicians and nurses was recruited using random sampling stratified by governorate. Participants completed mailed or online surveys addressing their practices, attitudes, role perceptions, and self-efficacy regarding SBIRT use. RESULTS: This study revealed that 57.8% of healthcare professionals were not familiar with the SBIRT model and that 76.2% did not practice SBIRT in their setting. The majority addressed the problem of substance use through educating and counseling adolescents about the dangers of substance use (84.2%) and encouraged them to stop (82%) but only 2% reported using standardized instruments for substance use screening. Most participants (88.1%) reported their willingness to use SBIRT in their clinical practice and 92.4% expressed an interest in receiving SBIRT training. Overall, the results showed positive attitudes (M = 4.38, SD = 0.89) and role responsibility (M = 4.47, SD = 1.62) toward addressing substance use in adolescents, in addition to a high level of perceived self-efficacy in addressing substance use (M = 4.04, SD = 0.92). Our results showed minimal differences between nurses' and physicians' perceptions and self-efficacy regarding SBIRT use. CONCLUSIONS: Our study confirms the lack of a standardized approach toward adolescent substance use screening and intervention by primary healthcare providers in Lebanon but revealed the readiness and willingness to receive training and proper support to adopt an evidence-based approach such as SBIRT.

Substance craving changes in university students receiving heart rate variability biofeedback: A longitudinal multilevel modeling approach.

BACKGROUND: Previously published findings from a study of university students living in substance use disorder (SUD) recovery housing showed an eight-session heart rate variability biofeedback (HRVB) intervention significantly reduced craving. That study, however, uncovered pronounced inter-participant variability in craving change patterns through the course of HRVB that warranted further exploration. The purpose of the current investigation was to examine how within- and between-person factors may have differentially influenced craving changes. METHODS: A longitudinal multilevel modeling approach was used with time at level-1 nested within persons at level-2. Multilevel models of change were estimated to model craving trajectories and predictor relationships over time as a function of age, sex, length of abstinence, daily HRVB practice, anxiety, depression, and stress. RESULTS: A quadratic pattern of craving reductions was found, indicating that craving reductions accelerated over time for some participants. Daily HRVB practice of >12 min and older age significantly enhanced craving reductions over time. Increases in depressive symptoms attenuated the effects of HRVB on craving. The other predictors were not significantly associated with craving in this study. The true R2 for the final model indicated that 20.5% of the variance in craving was explained by older age, daily HRVB >12 min, and within-person changes in depression. CONCLUSIONS: HRVB shows promise as an accessible, scalable, and cost-effective complementary anti-craving intervention. Healthcare providers may help persons recovering from SUD to better manage substance craving by the routine and strategic use of HRVB practice.

Current Evidence on Heart Rate Variability Biofeedback as a Complementary Anticraving Intervention.

BACKGROUND: The limited success of conventional anticraving interventions encourages research into new treatment strategies. Heart rate variability biofeedback (HRVB), which is based on slowed breathing, was shown to improve symptom severity in various disorders. HRVB, and certain rates of controlled breathing (CB), may offer therapeutic potential as a complementary drug-free treatment option to help control substance craving. METHODS: This review evaluated current evidence on the effectiveness of HRVB and CB training as a complementary anticraving intervention, based on guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies that assessed a cardiorespiratory feedback or CB intervention with substance craving as an outcome were selected. Effect sizes were calculated for each study. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to evaluate the quality of each study reviewed. RESULTS: A total of eight articles remained for final review, including controlled studies with or without randomization, as well as noncontrolled trials. Most studies showed positive results with a variety of methodological quality levels and effect size. Current HRVB studies rated moderately on methodological rigor and showed inconsistent magnitudes of calculated effect size (0.074-0.727) across populations. The largest effect size was found in a nonclinical college population of high food cravers utilizing the most intensive HRVB training time of 240 min. CONCLUSIONS: Despite the limitations of this review, there is beginning evidence that HRVB and CB training can be of significant therapeutic potential. Larger clinical trials are needed with methodological improvements such as longer treatment duration, adequate control conditions, measures of adherence and compliance, longitudinal examination of craving changes, and more comprehensive methods of craving measurement.

Assessing heart rate variability biofeedback as an adjunct to college recovery housing programs.

Heart rate variability biofeedback (HRV BFB) shows promise as an adjunct intervention for individuals receiving treatment for substance use disorder (SUD), potentially due to its capacity to reduce craving and negative affect. The present study sought to examine the utility of integrating HRV biofeedback into a college recovery housing program and gauging its ability to reduce craving and negative affect in young adults in remission from SUD. Forty-six residents of an SUD recovery house at a public university in the northeastern United States took part in a non-randomized controlled trial. The active intervention was 12 weeks of HRV BFB performed over a college semester. The control intervention was a semester-long, waitlist condition. Changes in craving, perceived stress, anxiety, and depressive symptoms were measured across time during the active HRV BFB intervention and compared to changes that occurred during the waitlist period using piecewise regression analyses. Significant reductions in craving were noted during HRV BFB, but not during the waitlist control condition; however, the difference in slopes between conditions was not statistically significant. Levels of self-reported craving, stress, anxiety, and depression varied substantially between participants and across time. The results suggest that use of HRV BFB in the college recovery setting as a tool to help reduce craving warrants further examination, particularly among individuals with elevated craving. Added value of HRV BFB comes from the fact that it can be easily and affordably implemented in everyday life.

Screening adolescents for substance use: The role of NPs in school settings.

NPs have a key role in screening for adolescent substance use in school settings. This article provides evidence-based information on the prevalence and consequences of adolescent substance use, discusses standardized substance use screening and brief interventions using the CRAFFT tool, and suggests relevant practice and policy implications.