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BACKGROUND: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. OBJECTIVE: This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. METHODS: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. RESULTS: Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. CONCLUSIONS: These ï¬ndings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. TRIAL REGISTRATION: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652.
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Dor Crônica , Estudos de Viabilidade , Manejo da Dor , Autogestão , Humanos , Dor Crônica/terapia , Dor Crônica/psicologia , Autogestão/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Adulto , Internet , Pesquisa Qualitativa , Idoso , Intervenção Baseada em Internet , CanadáRESUMO
BACKGROUND: Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. OBJECTIVE: We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). METHODS: We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). RESULTS: In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed "chapters"), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. CONCLUSIONS: The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial.
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BACKGROUND: Wellness is a promising area of research in multiple sclerosis (MS); however, considerable questions remain regarding the efficacy of behavioral interventions to improve wellness and which delivery methods yield favorable results. OBJECTIVE: To evaluate the efficacy of a wellness intervention consisting of diet, stress reduction techniques, sleep hygiene, and exercise, delivered via a 7-week web-based program with no tailored intervention support (e.g., counseling or resources) from the study team, on quality of life (QoL) and fatigue among people with MS. METHODS: Individuals (n = 100) with self-reported physician's diagnosis of relapsing-remitting MS or clinically isolated syndrome were recruited to enroll in this randomized waitlist-control trial consisting of three timepoints at 0, 12, and 24 weeks. Participants were randomized to begin the intervention at baseline (INT; n = 51) or to a waitlist to begin the intervention after the 12-week timepoint (WLC; n = 49), and both groups were followed for 24 weeks. RESULTS: At 12-weeks, 95 participants (46 INT and 49 WLC) completed the primary endpoint and 86 (42 INT and 44 WLC) completed the 24-week follow-up. Compared to baseline, the INT group had a significant increase in physical QoL (5.43 ± 1.85; P = 0.003) at 12-weeks which was maintained at 24-weeks. Physical QoL values in the WLC group did not significantly increase between weeks 12 and 24 (3.24 ± 2.03; P = 0.11); however, physical QoL values significantly improved compared to week 0 values (4.00 ± 1.87; P = 0.033). Neither group had significant changes in mental QoL. The INT group had a mean baseline to 12-week change of 5.06 ± 1.79 (P = 0.005) for MFIS and -0.68 ± 0.21 (P = 0.002) for FSS, both of which were maintained at 24-weeks. The 12- to 24-week changes for the WLC group were -4.50 ± 1.81 (P = 0.013) for MFIS and -0.44 ± 0.17 (P = 0.011) for FSS. At 12-weeks, the INT group had significantly greater reductions in fatigue compared to the WLC (P = 0.009 for both MFIS and FSS). There were no between-group mean differences for physical or mental QoL, but a significantly higher proportion of participants had clinically significant improvement in physical QoL in the INT group (50%) compared to the WLC group (22.5%) at 12-weeks (P = 0.006). The 12-week intervention effect was similar during the active intervention phase (i.e., baseline to 12 weeks for INT and 12 to 24 weeks for WLC) in each group. Course completion rates significantly differed between groups with 47.9% of the INT group and 18.8% of the WLC group completing the course (P = 0.01). CONCLUSION: A wellness intervention delivered via a web-based program, without tailored support, resulted in significant improvements in fatigue compared to control. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT05057676.
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Esclerose Múltipla , Autogestão , Humanos , Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Qualidade de Vida , Fadiga/etiologia , Fadiga/terapia , Fadiga/psicologia , InternetRESUMO
BACKGROUND: Patients with colorectal cancer (CRC) receiving chemotherapy often experience psychoneurological symptoms (PNS; ie, fatigue, depression, anxiety, sleep disturbance, pain, and cognitive dysfunction) that negatively impact both patients' and their caregivers' health outcomes. Limited information is available on PNS management for CRC patient and caregiver dyads. OBJECTIVE: The purposes of this study are to (1) develop a web-based dyadic intervention for patients with CRC receiving chemotherapy and their caregivers (CRCweb) and (2) evaluate the feasibility, acceptability, and preliminary effects of CRCweb among patient-caregiver dyads in a cancer clinic. METHODS: A mixed methods approach will be used. Semistructured interviews among 8 dyads will be conducted to develop CRCweb. A single-group pre- and posttest clinical trial will be used to examine the feasibility, acceptability, and preliminary effects of the intervention (CRCweb) among 20 dyads. Study assessments will be conducted before (T1) and after intervention (T2). Content analysis will be performed for semistructured interviews. Descriptive statistics will be calculated separately for patients and caregivers, and pre-post paired t tests will be used to evaluate treatment effects. RESULTS: This study was funded in November 2022. As of April 2023, we have obtained institutional review board approval and completed clinical trial registration and are currently recruiting patient-caregiver dyads in a cancer clinic. The study is expected to be completed in October 2024. CONCLUSIONS: Developing a web-based dyadic intervention holds great promise to reduce the PNS burden in patients with CRC receiving chemotherapy and their caregivers. The findings from this study will advance intervention development and implementation of symptom management and palliative care for patients with cancer and their caregivers. TRIAL REGISTRATION: ClinicalTrials.gov NCT05663203; https://clinicaltrials.gov/ct2/show/NCT05663203. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48499.
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BACKGROUND: In behavioral weight loss interventions, participants are asked to set weekly goals to support long-term habits that lead to weight loss. Although participants are asked to set and accomplish weekly goals, we do not know how often they do this and whether doing so is associated with weight loss. Web-based weight loss interventions allow for the analysis of participant engagement data, including how participants articulate their goals and accomplishments. OBJECTIVE: Using engagement data from a web-based weight loss intervention, we examined whether participants articulating their goals and accomplishments in measurable and repeating terms were associated with greater weight loss. METHODS: Adults with overweight or obesity received a 12-week Facebook-delivered weight loss intervention based on the Diabetes Prevention Program Lifestyle Intervention. Participants replied to conversation threads that queried about their goals and accomplishments. Two independent coders classified participants' posts that articulated goals or accomplishments as measurable or repeating. Crude and age-adjusted linear regression models were used to examine the relationship between the frequency of post type and percent weight loss. RESULTS: Participants (N=53; n=48, 91% female; n=48, 91% non-Hispanic White) were on average 46.2 (SD 10.5) years old with a mean BMI of 32.4 (SD 4.8) kg/m2. Over 12 weeks, participants shared a median of 4 (IQR 1-8) posts that reported goals and 10 (IQR 4-24) posts that reported accomplishments. Most participants shared ≥1 post with a goal (n=43, 81%) and ≥1 post with an accomplishment (n=47, 89%). Each post reporting a goal was associated with 0.2% greater weight loss (95% CI -0.3% to 0.0%). Sharing ≥1 post with a repeating goal was associated with an average of 2.2% greater weight loss (95% CI -3.9% to -0.4%). Each post with a repeating goal was associated with an average of 0.5% greater weight loss (95% CI -1.0% to 0.0%). Sharing ≥1 post with measurable and repeating goals was associated with an average of 1.9% greater weight loss (95% CI -3.7% to -0.2%). Sharing each post with an accomplishment was associated with an average of 0.1% greater weight loss (95% CI -0.1% to 0.0%). Every post with an accomplishment that was repeating was associated with an average of 0.2% greater weight loss (95% CI -0.3% to 0.0%). Sharing other types of goals and accomplishments was not associated with weight loss. CONCLUSIONS: In a web-based weight loss intervention, stating goals in repeating or both measurable and repeating terms was associated with greater weight loss, but simply stating them in measurable terms was not. For accomplishments, only those articulated in repeating terms were associated with greater weight loss. Posts about one-time goals and accomplishments represent an opportunity to encourage planning for future behaviors. Future research should examine if stating goals and accomplishments in repeating terms signals habit formation.
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Objetivos , Redução de Peso , Adulto , Humanos , Feminino , Criança , Masculino , Obesidade/terapia , Sobrepeso , InternetRESUMO
BACKGROUND: Substance abuse is the actual psychosocial harm, especially in young people confronted with content marketing in nowadays media environment, a risk factor for experiencing substance abuse. Based on the literature review, education designed based on the cognitive-behavioral model and planning models, such as using a social marketing framework, is the most effective method to prevent addictive substance abuse. Also, media literacy related to substance abuse and the prototype willingness model is considered a new integrated approach to present the intervention measures' desired results. METHODS: The present study evaluates an intervention program based on media literacy on substance abuse prevention among students using an integrated social marketing approach. This study aims to complete the SMART model's sixth and seventh stages, implementing intervention and evaluation. Participants will be students of Hamadan University, Iran. Randomization will occur at the university and school levels, and gathered data will appear at two-time (i.e., pre-test and three months follow-up). Intervention group students will obtain both substance abuse prevention education and substance abuse media literacy (SAML) education between pre-test and 3 months post-test. Students in the delayed intervention will be given this education after study accomplishment; this group will receive their regular courses except for substance abuse prevention and media literacy titles during education intervention. The outcome variables are intentions and substance abuse behavior based on prototype willingness and substance abuse media literacy. DISCUSSION: Evaluation of Substance abuse prevention and substance abuse media literacy education must be careful to ensure that they effectively enable people, especially in youth in the new media ecology and unique "Infomedia" ecosystems, in the current digital society. The SAML education plan's evaluation has the first web-based education program in universities. No prior research has psychometrically considered SAML in students in the SMART model's sixth and seventh stages. TRIAL REGISTRATION: IRCT20200914048719N1 . Registered on June 30, 2021.
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Marketing Social , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Humanos , Ecossistema , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Internet , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The coronavirus disease 2019 (COVID-19) pandemic has induced unhealthy lifestyles, particularly an increase in overweight and obesity, which have been shown to be associated with an increased risk of unfavorable COVID-19 outcomes. Web-based health programs could be a helpful measure, especially in times of severe restrictions. Therefore, the present study aimed to investigate the effects of regular attendance in a 12-week web-based weight loss program on COVIDAge, a new construct for risk assessment of COVID-19, and lifestyle-related cardiometabolic risk factors. N = 92 subjects with overweight and obesity (50.0 ± 10.8 years, 76.1% females, 30.5 ± 2.1 kg/m2) of this randomized controlled trial, which were assigned to an interactive (ONLINE: intervention group) or non-interactive (CON: control group) web-based weight loss program, were included in the data analysis. COVIDAge and cardiometabolic risk factors, including anthropometric outcomes, blood pressure, flow-mediated dilatation, and blood parameters, were assessed before and after the 12-week intervention phase. There was a significant group difference in the change of COVIDAge (ONLINE: -4.2%, CON: -1.3%, p = 0.037). The ONLINE group also showed significantly greater reductions in anthropometric outcomes and systolic blood pressure than the CON group (p < 0.05). To the authors' knowledge, this was the first study investigating the effects of regular attendance in a web-based health program on lifestyle-related risk factors for COVID-19. The results demonstrated that adults with overweight and obesity can improve their COVIDAge and specific cardiometabolic risk factors by using this interactive web-based weight loss program regularly. However, this needs to be confirmed by future studies. This study is registered at the German Clinical Trials Register (DRKS00020249, https://www.drks.de).
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COVID-19 , Doenças Cardiovasculares , Programas de Redução de Peso , Adulto , COVID-19/epidemiologia , Doenças Cardiovasculares/complicações , Feminino , Humanos , Internet , Estilo de Vida , Masculino , Obesidade/epidemiologia , Obesidade/terapia , Sobrepeso/terapia , Programas de Redução de Peso/métodosRESUMO
OBJECTIVE: To examine the effectiveness of a web-based clinical pedagogy program on nurse preceptors' clinical teaching competency, self-efficacy, and attitudes toward web-based learning in comparison to face-to-face course. BACKGROUND: Preceptorship is a dynamic educational process that requires designing, and implementing various teaching strategies, evaluation, assessment and feedback. Web-based learning has been recognized as an effective learning approach for nursing professional development. DESIGN: A prospective quasi-experimental approach with two-group pre-test and post-test repeated measures was adopted. METHODS: The web-based clinical pedagogy program was provided to the preceptors in the experimental group, while control group received the face-to-face preceptorship course. Clinical Teaching Competence Inventory (CTCI), Preceptor Self-efficacy Assessment Instrument (PSEQ), and Attitudes toward Web-based Continuing Learning Survey (AWCLS) were used to evaluate preceptors' learning outcomes. Data were collected at three time points - before, immediately after the learning program, and after 6 months of the clinical teaching experience. RESULTS: A total of 150 nurses (75 participants/group) were recruited from a tertiary hospital in Singapore from July 2018 to June 2020. The results from the repeated measures analysis of covariance showed that there was a significant interaction effect (group x time) on the overall CTCI score after adjusting for covariate (F = 5.390, p = 0.005). However, there were no significant interaction effect (group x time) on PSEQ (F = 2.693, p = 0.070) and overall AWCLS score (F = 1.341, p = 0.264) between the two groups across the three time points. CONCLUSION: The web-based clinical pedagogy program produced outcomes comparable to the face-to-face program in terms of preceptors' clinical teaching competence and self-efficacy. The innovative and cost-effective web-based clinical pedagogy program provided professional development and the flexibility to accommodate preceptors' busy work schedules. Online learning has become increasingly popular during the COVID-19 pandemic and the web-based clinical pedagogy program was implemented when face-to-face workshop was not feasible.
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COVID-19 , Pandemias , Competência Clínica , Humanos , Internet , Preceptoria , Estudos Prospectivos , SARS-CoV-2RESUMO
Nurse preceptors are key stakeholders in providing quality clinical education. This study aimed to explore the perspectives of nurse preceptors on a web-based clinical pedagogy program and clinical teaching. A descriptive qualitative design was adopted. The program was made accessible to the nurse preceptors who were assigned nursing students from July 2019 to June 2020. Upon completion of clinical teaching, a total of 19 nurse preceptors participated in four focus group discussions. The discussions were audio recorded and transcribed verbatim, and thematic analysis was conducted. Five themes, with 11 subthemes, emerged: (i) Undergoing the process of self-awareness and development; (ii) Mastering newly acquired skills to refine own teaching approach; (iii) Implementing consistent evaluation and constructive feedback; (iv) Dual roles and responsibilities of preceptor; and (v) Benefits and barriers of the program. This study highlighted the knowledge and skills preceptors gained through the program which gave them newfound confidence and facilitated their clinical teaching and evaluation. As the shift towards online learning progresses, web-based learning can be a useful platform for professional development of nurse preceptors.
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Preceptoria , Estudantes de Enfermagem , Competência Clínica , Humanos , Internet , Pesquisa Qualitativa , EnsinoRESUMO
BACKGROUND: Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using. OBJECTIVE: This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation. METHODS: Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests-Mann-Whitney and Kruskal-Wallis tests-to compare the 4 e-usage groups-feeling outsider, being uninterested, reflecting benefit, and enthusiastic using-in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory. RESULTS: The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; P=.03) and lower for physical fitness (MD -0.72; 95% CI -1.4 to -0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD -55.8; 95% CI -110.7 to -0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD -7.3; 95% CI -13.5 to -1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence. CONCLUSIONS: The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles.
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BACKGROUND: Atrial fibrillation (AF) is related to a variety of chronic diseases and life-threatening complications. It is estimated that by 2050, there will be 72 million patients with AF in Asia, of which 2.9 million will have AF-associated stroke. AF has become a major issue for health care systems. OBJECTIVE: We aimed to evaluate the effects of a web-based integrated management program on improving coping strategies, medication adherence, and health-related quality of life (HRQoL) in patients with AF, and to detect the effect on decreasing readmission events. METHODS: The parallel-group, single-blind, prospective randomized controlled trial recruited patients with AF from a medical center in northern Taiwan and divided them randomly into intervention and control groups. Patients in the intervention group received the web-based integrated management program, whereas those in the control group received usual care. The measurement tools included the Brief Coping Orientation to Problems Experienced (COPE) scale, Medication Adherence Rating Scale (MARS), the three-level version of the EuroQoL five-dimension self-report questionnaire (EQ-5D-3L), and readmission events 2 years after initiating the intervention. Data were collected at 4 instances (baseline, 1 month, 3 months, and 6 months after initiating the intervention), and analyzed with generalized estimating equations (GEEs). RESULTS: A total of 231 patients were recruited and allocated into an intervention (n=115) or control (n=116) group. The mean age of participants was 73.08 (SD 11.71) years. Most participants were diagnosed with paroxysmal AF (171/231, 74%), and the most frequent comorbidity was hypertension (162/231, 70.1%). Compared with the control group, the intervention group showed significantly greater improvement in approach coping strategies, medication adherence, and HRQoL at 1, 3, and 6 months (all P<.05). In addition, the intervention group showed significantly fewer readmission events within 2 years (OR 0.406, P=.03), compared with the control group. CONCLUSIONS: The web-based integrated management program can significantly improve patients' coping strategy and medication adherence. Therefore, it can empower patients to maintain disease stability, which is a major factor in improving their HRQoL and reducing readmission events within 2 years. TRIAL REGISTRATION: ClinicalTrials.gov NCT04813094; https://clinicaltrials.gov/ct2/show/NCT04813094.
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Fibrilação Atrial , Qualidade de Vida , Idoso , Fibrilação Atrial/tratamento farmacológico , Humanos , Internet , Adesão à Medicação , Readmissão do Paciente , Estudos Prospectivos , Método Simples-CegoRESUMO
BACKGROUND: Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. OBJECTIVE: The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. METHODS: BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e-mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth-the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7%). Semistructured interviews were performed with the participants (70/847, 8.3%) and analyzed using content analysis. RESULTS: There were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants' engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms. CONCLUSIONS: There are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention.
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In this study, a web-based behavioral intervention was designed, which aimed to reduce exposure to phthalate metabolites, bisphenol A, triclosan, and parabens in mothers with young children. A randomized controlled design with two groups was used to verify the effects of the intervention pre- and post-test. In total, 51 mothers participated in the study, categorizing 26 and 25 in the intervention and control groups, respectively. The web-based behavioral intervention focused on changes in diet, personal care products, and health behavior and reinforced behavior through encouragement. This program included an educational video, a game for locating endocrine disruptors at home, a method for locating facilities potentially emitting endocrine disruptors, resources, and a questions and answers mode. Data were collected from May 18 to June 30, 2020. Participants allocated to the intervention group were provided access to the behavioral intervention website via a computer or smartphone. Participants allocated to the control group were sent written information about endocrine disruptors via mail. For both the intervention and control groups, questionnaire results and maternal urine samples were assessed at baseline, during the intervention, and after one month. After the intervention, the urinary concentrations of mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-oxohexyl) phthalate (MEOHP), bisphenol A (BPA), methylparaben (MP), ethylparaben (EP), and propylparaben (PP) were found to be significantly decreased in the intervention group. Compared with the control group, the intervention group showed significantly decreased urinary geometric mean values of MEHP, MEOHP, BPA, MP, and PP after one month compared with those during the intervention (3.8%, 16.3%, 28.4%, 9.2%, and 24.4%, respectively). Hence, the web-based behavioral intervention was effective at reducing the exposure to endocrine disruptors in mothers with young children.
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Poluentes Ambientais , Ácidos Ftálicos , Triclosan , Compostos Benzidrílicos , Criança , Pré-Escolar , Exposição Ambiental/análise , Feminino , Humanos , Internet , Mães , Parabenos/análise , FenóisRESUMO
BACKGROUND: Heavy cannabis use is associated with adverse physical and mental health effects. Despite available effective treatments, the majority of heavy cannabis users does not seek professional help. Web-based interventions can provide an alternative for cannabis users who are reluctant to seek professional help. Several web-based cannabis interventions are effective in reducing cannabis use; however, the effect sizes are typically small and attrition rates are typically high. This suggests that web-based programs can be an effective cannabis use intervention for some, while others may need additional substance use treatment after completing a web-based intervention. Therefore, it is important that web-based interventions do not solely focus on reducing cannabis use, but also on improving attitudes towards substance use treatment. The Screening Brief Intervention and Referral to Treatment (SBIRT) approach appears to be well suited for the purpose of reducing cannabis use and improving substance use treatment utilization. Based on the SBIRT approach-and based on cognitive behavioral therapy (CBT) and motivational interviewing (MI)-we developed the Internet-based cannabis reduction intervention ICan. METHODS/DESIGN: This protocol paper presents the design of a randomized controlled trial (RCT) in which we evaluate the effectiveness of the ICan intervention compared to four online modules of educational information on cannabis in a sample of Dutch frequent cannabis users. The primary outcome measure is frequency of cannabis use. Secondary outcome measures include the quantity of cannabis used (grams), the attitudes towards seeking help and the number of participants who enter specialized treatment services for cannabis use-related problems. DISCUSSION: To the best of our knowledge, ICan is the first Internet-based intervention for cannabis users that combines screening, a brief intervention-based on CBT and MI-and referral to treatment options. TRIAL REGISTRATION: The study is registered in the Netherlands Trial Register; identifier NL7668 . Registered on 17 April 2019.
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Cannabis , Terapia Cognitivo-Comportamental , Intervenção Baseada em Internet , Entrevista Motivacional , Humanos , Internet , Países Baixos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
OBJECTIVE: Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma. MATERIALS AND METHODS: CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air. RESULTS: CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees. CONCLUSION: CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma. PRACTICE IMPLICATIONS: A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.
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Asma , Intervenção Baseada em Internet , Autogestão , Adolescente , Asma/terapia , Humanos , Cidade de Nova Iorque , Instituições AcadêmicasRESUMO
BACKGROUND: Young Australians (16-25 years) have the highest rates of past-month cannabis use in the world. Cannabis use increases the risk of alcohol and other drug disorders and depressive disorders, and has a robust dose-response association with psychotic experiences (PEs) and disorders. PEs are subthreshold positive psychotic symptoms, including delusions and hallucinations, which increase the risk of substance use, depressive or anxiety disorders, and psychotic disorders. Access to effective web-based early interventions targeting both cannabis use and PEs could reduce such risk in young people. OBJECTIVE: The objective of this study is to determine the efficacy and cost-effectiveness of the Keep it Real web-based program compared to an information-only control website among young cannabis users (16-25 years) with PEs. METHODS: Participants are recruited online, and consenting individuals meeting inclusion criteria (aged 16-25 years, who have used cannabis in the past month and experienced PEs in the past 3 months) are automatically randomized to either the Keep it Real web-based program (n=249) or an information-only control website (n=249). Both websites are self-guided (fully automated). The baseline and follow-up assessments at 3, 6, 9, and 12 months are self-completed online. Primary outcome measures are weekly cannabis use, PEs, and the relative cost-effectiveness for quality-adjusted life years. Secondary outcomes include other substance use and related problems, PE-related distress, cannabis intoxication experiences, severity of cannabis dependence, depression/anxiety symptoms, suicidality, and mental well-being and functioning. RESULTS: Recruitment commenced in February 2019, and the results are expected to be submitted for publication in mid-2021. CONCLUSIONS: This study protocol describes a large randomized controlled trial of a new web-based program for young cannabis users experiencing PEs. If effective, the accessibility and scalability of Keep it Real could help reduce growing public health concerns about the significant social, economic, and health impacts of cannabis use. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001107213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374800. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15803.
RESUMO
Objective: The purpose of this project was to create a web-accessible drug education program that would positively impact student knowledge and perceptions. Materials and Methods: An interactive computer module (Interactive Module to Halt Abuse of Prescriptions in Preteens and Youth [I'M HAPPY]) was created using a combination of e-learning and animation software. The module used narrated illustrations, animations, and games to explain what over-the-counter (OTC) and prescription drugs are, how they are used correctly, and what risks they carry. Animated drug refusal scenarios with user-determined outcomes were also incorporated. Sixth-grade students were asked to complete the module online and were given a 14-question pretest and posttest on the definitions, adverse effects, and proper use of OTC and prescription medicines. They were also asked to rank the perceived helpfulness of several drug refusal strategies. Student opinions about the computer module itself were collected on the posttest. Results: Students (n = 34) scored better on quiz questions following the module. They also showed increased favorability toward three of four drug refusal strategies after completing the module, with a greater proportion ranking these strategies "Very Helpful." Most students indicated they learned new things from the module (79%) and found it enjoyable (88%) and easy to use (97%). Conclusion: The I'M HAPPY program improved student knowledge of OTC and prescription drugs and enhanced perceptions of the helpfulness of certain drug refusal strategies. The computer module was considered enjoyable and easy to use, and can be easily disseminated to any student or classroom having internet access.
Assuntos
Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Jogos de Vídeo/normas , Criança , Feminino , Humanos , Internet , Aprendizagem , Masculino , Projetos Piloto , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Interface Usuário-Computador , Jogos de Vídeo/psicologiaRESUMO
BACKGROUND: Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students' clinical learning to enhance their clinical competencies. OBJECTIVE: This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors' clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. METHODS: A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. RESULTS: Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. CONCLUSIONS: The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education.
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Competência Clínica/normas , Aprendizagem/fisiologia , Enfermagem/métodos , Preceptoria/organização & administração , Adulto , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: School-based comprehensive sexual health education can improve adolescent health outcomes, and web-based programs are a promising approach to overcoming challenges associated with teacher-led formats by ensuring that students receive content that is consistent, unbiased, and medically accurate. However, many adolescents do not receive high-quality sexual health education and turn to the media for information about sex and relationships. Consumption of sexual media messages is related to early and risky sexual behaviors. Media literacy education (MLE) is a proven approach to adolescent sexual health promotion, yet there are no rigorously evaluated web-based MLE programs to promote sexual and relationship health among high school students. METHODS: This study will test the efficacy, in a randomized controlled trial, of Media Aware, a web-based comprehensive sexual health promotion program for high school students that uses an MLE approach. Participants will be students in 9th and 10th grade health classes in participating schools. Randomization will take place at the school level, and data collection will take place at three time points (i.e., pretest, posttest, and 3 months follow-up). Students in the intervention classrooms will receive Media Aware between pretest and posttest, and students in the delayed-intervention classrooms will receive Media Aware after study completion (i.e., after 3 months follow-up data collection). Students in the delayed-intervention classes will receive their standard health education programming, and teachers in the delayed-intervention classes will be asked to refrain from teaching sexual health or MLE during the study timeframe. The primary outcome variables are intentions, willingness, and behaviors related to sexual health and sexual activity. DISCUSSION: There are currently no evidence-based comprehensive sexual health programs for high school students that are web-based and use an MLE approach. Media Aware has the potential to be an engaging, less expensive, and effective sexual and relationship health program for high school students. Media Aware is unique in two important ways: (1) the web-based format reduces many of the challenges to fidelity of implementation associated with teacher-led sexual health education; and (2) the MLE approach addresses a commonly ignored influence on adolescent sexual and relationship health, namely, media. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04035694. Registered on 29 July 2019. Contact for Scientific Queries: Tracy Scull, PhD (Principal Investigator); innovation Research & Training at 5316 Highgate Drive, Suite 121, Durham, North Carolina, USA 27713; tscull@irtinc.us.
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Promoção da Saúde/organização & administração , Intervenção Baseada em Internet , Instituições Acadêmicas/organização & administração , Educação Sexual/organização & administração , Adolescente , Saúde do Adolescente , Feminino , Promoção da Saúde/métodos , Comportamentos de Risco à Saúde , Humanos , Internet , Alfabetização/psicologia , Masculino , North Carolina , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Educação Sexual/métodos , Saúde Sexual , Estudantes/psicologiaRESUMO
Patients undergoing radiation treatment for head and neck cancer experience significant side-effects that can impact a wide range of daily activities. Patients often report receiving insufficient information during and after treatment, which could impede rehabilitation efforts; they may also encounter practical and logistical barriers to receipt of supportive care. Thus, we developed a web-based program, My Journey Ahead, to provide information and strategies for managing symptom-focused concerns, which may be easily accessed from the patient's home. The purpose of this study was to evaluate patient acceptability and satisfaction with the My Journey Ahead program. In Phase 1, five patients with head and neck squamous cell carcinoma (HNSCC) reviewed the web-based program and provided initial feedback, which informed program modifications. In Phase 2, 55 patients were recruited to evaluate the program. Patient assessments were obtained prior to and after use of the web-based program, and included measures of psychological distress, self-efficacy in coping with cancer-related issues, and satisfaction with the website. Among the 55 patients enrolled, 44 logged in and viewed the web-based program. Participants reported high levels of satisfaction with the information received, and indicated that the website was interesting and easy to use. Older age and higher levels of self-efficacy in coping were each associated with higher levels of satisfaction with the website. In summary, the web-based program was well-received by patients, the majority of whom found it to be informative and useful. An easy-to-use web-based program, particularly for older patients who may have difficulty locating reliable evidence-based information on the internet, may be helpful in addressing survivors' needs in symptom management and coping with cancer. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/, NCT02442336.