Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study.

BACKGROUND: Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. OBJECTIVE: The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. METHODS: NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. RESULTS: NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. CONCLUSIONS: If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/60361.

Chatbot-Led Support Combined With Counselor-Led Support on Smoking Cessation in China: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: China has a large population of smokers, with half of them dependent on tobacco and in need of cessation assistance, indicating the need for mobile health (mHealth) to provide cessation support. OBJECTIVE: The study aims to assess the feasibility and preliminary effectiveness of combining chatbot-led support with counselor-led support for smoking cessation among community smokers in China. METHODS: This is a 2-arm, parallel, assessor-blinded, pilot randomized controlled trial nested in a smoke-free campus campaign in Zhuhai, China. All participants will receive brief face-to-face cessation advice and group cessation support led by a chatbot embedded in WeChat. In addition, participants in the intervention group will receive personalized WeChat-based counseling from trained counselors. Follow-up will occur at 1, 3, and 6 months after treatment initiation. The primary smoking outcome is bioverified abstinence (exhaled carbon monoxide <4 parts per million or salivary cotinine <30 ng/mL) at 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, and quit attempts. Feasibility outcomes include eligibility rate, consent rate, intervention engagement, and retention rate. An intention-to-treat approach and regression models will be used for primary analyses. RESULTS: Participant recruitment began in March 2023, and the intervention began in April 2023. The data collection was completed in June 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences. CONCLUSIONS: This study will provide novel insights into the feasibility and preliminary effectiveness of a chatbot-led intervention for smoking cessation in China. The findings of this study will inform the development and optimization of mHealth interventions for smoking cessation in China and other low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT05777005; https://clinicaltrials.gov/study/NCT05777005. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58636.

Factors associated with completion of intensive adherence counseling among people living with HIV at a large referral hospital in Uganda: a retrospective analysis.

BACKGROUND: Among people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda. METHODS: In this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS: We studied 420 participants of whom 204 (48.6%) were aged 20-39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64-0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67-0.87), malnutrition (aRR 0.65, 95% CI 0.43-0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01-1.49) was associated with a higher likelihood of IAC completion. CONCLUSIONS: We found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate.

Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. OBJECTIVE: The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program-adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)-is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. METHODS: This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco's harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. RESULTS: The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. CONCLUSIONS: It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57236.

Effects of a Cognitive-Behavioral Group Counseling Program on Weight Bias Internalization and Psychological Outcomes Among Obese Youth in Mahasarakham University, Thailand.

BACKGROUND: Weight bias internalization (WBI) is a serious challenge because of its negative impact on psychological consequences. Although the cognitive-behavioral intervention has been applied to reduce WBI, little is known about its effectiveness among Thai obese youth. Thus, this study sought to determine the effects of a cognitive-behavioral group counseling (CBGC) program on WBI and psychological outcomes in obese youths. Study Design: A randomized controlled trial. METHODS: Eighty obese youths were randomly allocated to two intervention (n=40) and control (n=40) groups. The intervention group received a CBGC program in three sessions with ten activities, while the control group performed their usual counseling process. Data were collected through standardized interviewers with a structured interview questionnaire. The chi-square test, independent samples t-test, Mann-Whitney U test, repeated measure ANOVA, and multivariate linear regression were applied for data analyses. RESULTS: At the follow-up visit, the intervention group had a significant decrease in the mean of WBI, depression, and perceived stress and an increased mean of self-esteem compared to the control group. After adjusting baseline characteristics and baseline outcome values, the intervention also significantly improved WBI (B=-6.82, P<0.001), depression (B=-4.17, P<0.001), perceived stress (B=-6.01, P<0.001), and self-esteem (B=5.07, P<0.001). CONCLUSION: The CBGC program effectively reduced WBI, depression, and perceived stress while improving self-esteem among obese youths. This study recommends that group counseling programs be employed as part of a counseling process for obese youth who have experienced WBI.

The influence of social support in the prevention and treatment of postpartum depression: An intervention-based narrative review.

Postpartum depression (PPD) is a mental health disorder that affects 10%-15% women globally. Longitudinal and meta-analyses have consistently demonstrated the negative impacts of PPD on both the affected mothers and subsequent infant development. Given the consideration that antidepressant side effects in breastfeeding infants and the cost-effectiveness considerations of psychotherapies, attention has been paid towards the promising role of social support interventions in order to prevent and reduce the PPD symptoms. Confirming the assertion, this narrative review examines the potential of five social support interventions to ameliorate PPD-related maternal and infant outcomes. The wide implications of psychoeducational strategy, nurses' supportive and non-directive counselling and home-visiting approach are outlined. Furthermore, the evidence underlying the role of peer support, culturally tailored intervention and community-based participatory approach in PPD is elucidated. In clinical practice, this review reinforce the roles of discharge educational intervention led by the experienced nurse during the postpartum stay, in order to maintain psychological mental health among the postpartum mothers. More importantly, the skilled and competence public health nurses act as valuable assets in treating PPD, and this effective treatment alternative should be considered by healthcare planners. In future, major investigations will be strategized to discover the synergistic effects of combined social support approaches to yield a better outcome in the prevention and treatment of PPD.

Aus Klinik und Praxis / From Clinic and Practice. Aktuelle Ansätze und Methoden Systemischer Therapie und Beratung: KIKOS® verbindet Techniken und Systeme / Current Approaches and Methods of Systemic Therapy and Counselling: KIKOS® Combines Techniques and Systems.

Current Approaches and Methods of Systemic Therapy and Counselling: KIKOSR Combines Techniques and Systems Therapy with children and teens could often be more effective and sustainable if the therapeutic process included not only the family environment, but also the more distant environment, such as teachers and pedagogues from school and leisure activities. It is important to take a look at the principles of hypnotherapeutic and systemic therapy approaches and perhaps even beyond. Whenever working according to guidelines or manuals no longer shows success, it can be extremely helpful to interrupt those patterns by making use of a combination of different therapeutic techniques, such as PEP®, impact and embodiment techniques, as well as resource and solution-oriented approaches. KIKOS® is an approach that promotes tolerance of ambiguity in all systems, regardless of the basic therapeutic orientation, by combining techniques and systems while taking into account the individuality of client and practitioner.

[Dolodoc: a virtual pain management coach]. / Dolodoc : un coach virtuel pour mieux gérer la douleur chronique.

Dolodoc is a mobile application aimed at improving autonomy and quality of life for individuals living with chronic pain. Designed as a virtual coach, it offers counseling according to 7 important dimensions of quality of life. Activities, pain and fulfillment of the 7 dimensions of quality of life can be recorded in the application. Moreover, a report can be exported to enhance patient monitoring during clinical interactions. Dolodoc was developed with a user-centered approach and is based on scientific evidence related to the self-management of chronic pain. Indeed, counseling by the coach is based on a multimodal strategy, incorporating elements of physical activity, pacing, positive psychology, and relaxation, among others. Overall, Dolodoc is an innovation that can be used in various clinical settings with an individualized approach.

Dolodoc est une application ayant pour but d'améliorer l'autonomie et la qualité de vie des personnes vivant avec la douleur chronique. Conçue comme un coach virtuel, elle propose des conseils ainsi qu'un suivi d'activités se référant à 7 dimensions importantes pour la qualité de vie. Ces éléments sont consignables dans l'application et un rapport peut être exporté pour agrémenter le suivi du patient. Dolodoc a été développé selon une approche centrée sur l'utilisateur et se base sur des preuves scientifiques en lien avec l'autogestion des douleurs chroniques. En effet, les conseils sont multimodaux et intègrent, entre autres, l'activité physique, le pacing, la psychologie positive et la relaxation. Disponible gratuitement, Dolodoc est une innovation dont l'utilisation individualisée peut s'adapter à différents contextes cliniques.

Postpartum menstrual equity: Video and audio analysis of vaginal bleeding counseling during postpartum inpatient care at a southeastern US tertiary hospital.

BACKGROUND: Despite the universal nature of postpartum vaginal bleeding after childbirth and the importance of managing vaginal bleeding in the postpartum period to monitor health status, little is known about the information or products that birthing individuals are provided. Investigating current practices may offer insights to enacting more supportive and equitable postpartum care. OBJECTIVE: To evaluate the patterns and content of vaginal bleeding counseling provided to birthing parents while on a postnatal inpatient unit. DESIGN: Observational study of inpatient postpartum care. Birthing parents and their companions consented to video and audio recording of themselves, their infants, and healthcare team members during their postnatal unit stay. METHODS: Following IRB approval and in coordination with clinicians at a tertiary hospital in the southeastern United States, data were collected with 15 families from August to December 2020. A multidisciplinary team coded video and audio data from each family from 12 h before hospital discharge. This analysis evaluates patterns of vaginal bleeding counseling timing, content, and language concordance and thematic content of this communication. RESULTS: Birthing parent participants were self-identified Hispanic White (n = 6), non-Hispanic Black (n = 5), non-Hispanic White (n = 3), and non-Hispanic multi-race (n = 1). Six were Spanish-speaking and eight had cesarean section births. The timing, content, and language concordance of vaginal bleeding communication varied, with these topics mainly addressed in the hour preceding discharge. Twelve of the 15 birthing parents had communication on these topics between 2 and 5 times, 2 had one exchange, and 1 had no counseling on postpartum bleeding observed. Four of the six Spanish-speaking birthing parents had counseling on these topics that was not language concordant. Postpartum vaginal bleeding management involved the themes of access to products, patient safety, and meaningful counseling. There was a lack of adequate access, variation in accurate and respectful care, and a busy clinical environment with differences in information provided. CONCLUSION: Findings suggest that there are opportunities to strengthen clinical practices for more consistent, proactive, and language concordant vaginal bleeding and subsequent menstrual care postpartum. Menstrual equity is an important part of dignified and safe care.

Video analysis of when and what information on vaginal bleeding was shared between people who just gave birth and their healthcare team at the hospital.Why did we do the study? After birth, people must take care of vaginal bleeding. It is important for people in the hospital to recognize warning signs for too much bleeding, have access to pads, and feel supported by their healthcare team before discharging to home. There has been little research on experiences with inpatient counseling on postpartum vaginal bleeding­a part of the reproductive life cycle­for new parents. We wanted to watch and listen in hospital rooms so we could think about the best ways for healthcare providers to talk about vaginal bleeding. What did we do? We asked 15 people who just gave birth, people staying with them at the hospital, and their healthcare team if we could video and sound record in their hospital rooms. They could start and stop recording anytime. We only recorded people who agreed to be in the study. What did we learn? We watched recordings of the last 12 hours at the hospital before each family went home. We found that most of the time, the healthcare workers did not talk about vaginal bleeding. People who spoke Spanish did not always have someone interpreting into their language. Sometimes family members had to translate and ask for pads. Some people did not have enough pads or underwear and had to wait after asking for more. What does it mean? We found ways to improve teaching about vaginal bleeding after birth. We recommend always having an interpreter when needed, giving people enough pads and underwear in their rooms, including companions in the teaching, and having enough healthcare workers to answer requests. These ideas would improve the counseling and give everyone the support needed after giving birth.

The utilization of provider-initiated testing counselling services for citizens at risk of HIV/aids at the polyclinic of class IIA Abepura penitentiary in Papua province.

Objective: To analyse the factors related to the use of provider-initiated test and counselling services for inmates at high risk of HIV /AIDS. METHODS: This descriptive cross-sectional study was conducted at the Polyclinic of Class IIA Abepura Correctional Institution, Papua Province, Indonesia, from November to December 2020, and involved 140 inmates, of age 18 years or older selected by simple random sampling technique, at high risk of HIV after obtaining informed consent. All had been tested for HIV status were fluent in Indonesian and willing to participate in the study. The use of provider-initiated testing and counselling services was recorded in 112 (80%) cases. Data were collected using a structured questionnaire exploring aspects related to testing and counselling. Data were analysed using SPSS v.21. RESULTS: The association between use of provider-initiated testing and counselling services and acceptance of HIV/AIDSrelated stigma and discrimination was significant (odds ratio=20.781; p<0.001). The association between use of provider-initiated testing and counselling services was also significant with belief in its usefulness (odds ratio=12.372; p<0.001), family and institutional support (odds ratio = 9.993; p<0.001), need for services (odds ratio = 6.587; p<0.001), and knowledge of services (odds ratio = 6.130; p<0.001). Conclusion: It is essential to build a cross-programme collaboration between health workers and security officers in the form of regular counselling to reduce the stigma and discrimination among inmates.

Expectations and Preferences for Digital Cessation Treatment: Multimethods Study Among Older Adults Who Smoke Cigarettes.

BACKGROUND: To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group. OBJECTIVE: We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes. METHODS: Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms. RESULTS: Participants (12/20, 60% men; 15/20, 75% White; 4/20, 20% Black or African American; 1/20, 5% Asian) were currently smoking (17/20, 85%) or had recently quit (3/20, 15%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges. CONCLUSIONS: Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health.

Telehealth counseling plus mHealth intervention for cannabis use in emerging adults: Development and a remote open pilot trial.

INTRODUCTION: To improve treatment access for emerging adults with cannabis use disorder (CUD), we developed a telehealth counseling-plus-mHealth intervention and remotely conducted a single-arm open pilot study to preliminarily evaluate its feasibility in primary care. METHODS: A multidisciplinary team including youth developed the intervention using the structure of the MOMENT intervention: two weekly counselor-delivered Motivational Enhancement Therapy (MET) sessions, then two weeks of smartphone surveys (4 prompted/day) querying socioemotional contexts and cannabis use, with pre-programmed messages on report of personal triggers for use (Ecological Momentary Intervention; EMI). The team adapted the MET for virtual delivery; created material to enhance self-reflection, plan behavior change, and anticipate withdrawal; shortened the sessions; and tested them with five youth actors. EMI messages were created to align with the MET and programmed to minimize repetition. Patients aged 18-25 using recreational cannabis ≥3 days/week were recruited from an urban medical practice. Participants received the intervention and responded to surveys on satisfaction and burden. At baseline, post-intervention, and two months, participants reported behavior change readiness/importance/confidence and cannabis use. EMI engagement was calculated as % days with ≥1 phone survey completed. RESULTS: Fourteen eligible patients enrolled; 79 % used cannabis daily/near-daily and 100 % reported use problems. All completed both MET sessions and responded to EMI surveys. All agreed/strongly agreed that they felt respected by, comfortable with, and trust for the counselor and that the activities and discussion were helpful; all rated the MET sessions as very good/excellent. Technical issues were infrequent and minor. Median EMI engagement was 100 % (≥1 report/day) in each week. Behavior change confidence was higher post-intervention and importance and confidence were higher at two months vs. baseline. By two months, 11 participants had started to change cannabis use; median percent days of use in the past 30 days declined by 27 % and average times of use per use day declined by 28 %. All rated intervention quality as good, very good, or excellent. CONCLUSIONS: Emerging adults were highly satisfied and engaged with a telehealth MET counseling-plus-mHealth EMI intervention for cannabis use and reported higher motivation to change cannabis use and less use post-intervention and at 2-month follow-up.

From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling.

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

Assessing the validity of maternal report on breastfeeding counselling in Kosovo's primary health facilities.

BACKGROUND: Improving the quality of breastfeeding counselling delivered by primary care providers can improve breastfeeding outcomes and ultimately reduce mortality and morbidity of children and mothers. Accurate data on coverage and quality of primary care breastfeeding counselling is essential for monitoring progress; however, global and national indicators are limited. To help address this gap, this study validated indicators of receipt and quality of breastfeeding counselling during routine consultations for infant care at seven primary health facilities across Kosovo. METHODS: Mothers' reports of breastfeeding counselling received during routine consultations for their infants (0-12 months of age) were collected by exit interview in 2019 and 2021 (n = 609). Responses were compared against direct observation of their consultation using a structured checklist (reference standard) by a trained third-party observer at the primary care facility. We assessed 13 indicators; ten were related to the receipt and content of breastfeeding counselling, and three were specific to the provider's interpersonal skills. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. RESULTS: Ten indicators had an agreement rate above 70% and seven indicators had high overall individual-level validity (AUC ≥ 0.7). High prevalence indicators recorded high sensitivity and low specificity, and the inverse for low prevalence indicators. More subjective indicators were less reliable, e.g., mothers over-reported the prevalence of all three indicators related to providers' interpersonal skills. CONCLUSIONS: This study offers evidence on breastfeeding counselling quality by validating maternal reports of whether a provider discussed breastfeeding, the clinical content of that counselling, and how it was delivered. It is also situated in a primary care setting within a fragile state of which there is limited evidence. We observed that mothers reported accurately when asked directly to recall breastfeeding counselling services received. However, there is a need to further validate subjective questions about interpersonal skills and other measures for the 'experience of care' quality dimension.

A Scoping Review of Patient-Centered Perinatal Contraceptive Counseling.

INTRODUCTION: Contraceptive counseling during the perinatal period is an important component of comprehensive perinatal care. We synthesized research about contraceptive counseling during the perinatal period, which has not previously been systematically compiled. METHODS: We developed search criteria to identify articles listed in PubMed, Embase, and Popline databases published between 1992 and July 2022 that address patients' preferences for, and experiences of, perinatal contraceptive counseling, as well as health outcomes associated with this counseling. Search results were independently reviewed by multiple reviewers to assess relevance for the present review. Methods were conducted in accordance with PRISMA guidelines. RESULTS: Thirty-four articles were included in the final full text review. Of the included articles, 10 included implementation and evaluation of a contraceptive counseling method or protocol, and 24 evaluated preferences for or experiences of existing contraceptive counseling in the perinatal period. Common themes included the acceptability of contraceptive counseling in the peripartum and postpartum periods, and a preference for contraceptive counseling at some point during the antenatal period and before the inpatient hospital experience, and direct provider-patient discussion instead of video or written material. Multiple studies suggest that timing, content, and modality should be individualized. In general, avoiding actual or perceived directiveness and providing multi-modal counseling that includes both written educational materials and patient-provider conversations was desired. DISCUSSION: The perinatal period constitutes a critical opportunity to provide contraceptive counseling that can support pregnant and postpartum people's management of their reproductive futures. The reviewed studies highlight the importance of patient-centered approach to providing this care, including flexibility of timing, content, and modality to accommodate individual preferences.

Integrating point-of-care diabetes detection with lifestyle counselling in community settings: outcomes from Western Sydney, Australia.

INTRODUCTION: Early detection and prevention of type 2 diabetes and its complications are global health priorities. Optimal outcomes depend on individual awareness and proactive self-management of health risks. This study evaluates the effectiveness of a community-based diabetes detection and intervention program in a high-risk area in western Sydney, Australia. RESEARCH DESIGN AND METHODS: We collaborated with the Workers Lifestyle Group, Tamil Association Arts and Culture Association, and the National Aboriginal and Islanders Day Observance Committee to implement our program. Participants underwent HbA1C testing via point-of-care blood spot testing. They received personalized feedback, education on diabetes management, and were offered opportunities to enrol in lifestyle modification programs. Participants identified with pre-diabetes (HbA1C 5.7-6.4%) or diabetes (HbA1C > 6.4%) were advised to consult their General Practitioners (GPs). A follow-up questionnaire was distributed 3-8 months post-intervention to evaluate the programs usefulness and relevance and lifestyle changes implemented by the participants. RESULTS: Over eight months, 510 individuals participated. Of these, 19% had an HbA1C > 6.4%, and 38% had levels between 5.7 and 6.4%. Among those with diabetes, HbA1C levels ranged as follows: 56% <7%; 20% 7-7.9%; 18% 8-8.9%; and 5% >9%. Post intervention survey indicated that the program was well-received, with 62.5% of responses reporting lifestyle changes and 36.3% seeking further advice from their local healthcare providers. CONCLUSION: The study demonstrates a significant prevalence of pre-diabetes and diabetes in the community, similar to findings from larger-scale hospital and general practice studies. Point-of-care testing combined with personalized education effectively motivated participants toward healthier lifestyle choices and medical consultations. The paper discusses the scalability of this approach for broader population.

Effectiveness and User Experience of a Smoking Cessation Chatbot: Mixed Methods Study Comparing Motivational Interviewing and Confrontational Counseling.

BACKGROUND: Cigarette smoking poses a major public health risk. Chatbots may serve as an accessible and useful tool to promote cessation due to their high accessibility and potential in facilitating long-term personalized interactions. To increase effectiveness and acceptability, there remains a need to identify and evaluate counseling strategies for these chatbots, an aspect that has not been comprehensively addressed in previous research. OBJECTIVE: This study aims to identify effective counseling strategies for such chatbots to support smoking cessation. In addition, we sought to gain insights into smokers' expectations of and experiences with the chatbot. METHODS: This mixed methods study incorporated a web-based experiment and semistructured interviews. Smokers (N=229) interacted with either a motivational interviewing (MI)-style (n=112, 48.9%) or a confrontational counseling-style (n=117, 51.1%) chatbot. Both cessation-related (ie, intention to quit and self-efficacy) and user experience-related outcomes (ie, engagement, therapeutic alliance, perceived empathy, and interaction satisfaction) were assessed. Semistructured interviews were conducted with 16 participants, 8 (50%) from each condition, and data were analyzed using thematic analysis. RESULTS: Results from a multivariate ANOVA showed that participants had a significantly higher overall rating for the MI (vs confrontational counseling) chatbot. Follow-up discriminant analysis revealed that the better perception of the MI chatbot was mostly explained by the user experience-related outcomes, with cessation-related outcomes playing a lesser role. Exploratory analyses indicated that smokers in both conditions reported increased intention to quit and self-efficacy after the chatbot interaction. Interview findings illustrated several constructs (eg, affective attitude and engagement) explaining people's previous expectations and timely and retrospective experience with the chatbot. CONCLUSIONS: The results confirmed that chatbots are a promising tool in motivating smoking cessation and the use of MI can improve user experience. We did not find extra support for MI to motivate cessation and have discussed possible reasons. Smokers expressed both relational and instrumental needs in the quitting process. Implications for future research and practice are discussed.

A multimodal couple-coping intervention for enhancing sexual adjustment among breast cancer women: Study protocol for a randomised controlled trial.

AIM: To investigate the effects of a multimodal couple-based sexual health intervention for premenopausal women treated for breast cancer and their partners to provide personalised psychosexual care, and to understand participants' experience of, and adherence to, the intervention. METHODS: This is an assessor-blinded, randomised controlled trial. Premenopausal women treated for breast cancer (N = 160) and their partners will be recruited. Dyads will be randomised into an intervention (n = 80) or attention control (n = 80) group. The intervention group will receive the multimodal couple-based sexual health intervention over eight weeks. The intervention comprises five face-to-face and virtual individual couple counselling sessions combined with online reading, a chat-based discussion forum, and telephone calls. The intervention is based on level I-II evidence and a robust theoretical framework. The attention control group will receive usual care plus telephone calls comprising general greetings and reminders to complete follow-up surveys. Sexual adjustment, relationship quality and quality of life will be measured at baseline, after completion of the intervention, three months and six months post-intervention. The project will adhere to the CONSORT-EHEALTH checklist. Qualitative interviews will explore the participants' experience of, and adherence to, the intervention. DISCUSSION: This study will provide the first pragmatic evidence of the effectiveness of a multimodal couple-coping intervention to support premenopausal women and their partners to improve sexuality, relationship quality and quality of life after treatment for breast cancer. IMPLICATIONS FOR THE PROFESSION AND /OR PATIENT CARE: Sexual health is a neglected area in clinical practice, for patients and partners. The ever-growing population of women treated for breast cancer at younger age has created a more pressing need for the development of tailored sexual health interventions. If effective, this intervention could be incorporated into routine cancer care to provide better support and care for this patient population to enhance sexual health, intimacy and overall well-being. TRIAL REGISTRATION: ISRCTN35481498; prospectively registered on 08/05/2023.