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3.
Implement Sci ; 14(1): 54, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146788

RESUMO

BACKGROUND: Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. METHODS: As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. RESULTS: A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. CONCLUSION: Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Pessoal de Saúde/educação , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Escolar/organização & administração , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Projetos Piloto , Projetos de Pesquisa , Estados Unidos
4.
Invest. educ. enferm ; 37(2): [E07], 15-06-2019. Fig 1, Tab 1, Tab 2
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1007626

RESUMO

Abstract Objective. This work was conducted to determine the effectiveness of a nursing intervention, based on the motivational interview, to diminish preoperative anxiety in patients programmed for knee replacement surgery. Methods. Preventive type controlled and randomized clinical trial, on a sample of 56 patients programmed for knee replacement surgery in a clinic in Girardot (Colombia). Random assignment was made: an intervention group (n=28) and a control group (n=28). The six-question Amsterdam Preoperative Anxiety and Information Scale was applied before and after the intervention. The scale has a total score ranging from 5 to 30; the higher the score, the greater the preoperative anxiety. The nursing intervention was conducted in three sessions of motivational interview each lasting 40 min, during the six weeks prior to the surgical procedure; the control group received conventional management of education in the health institution. Results. The mean score of preoperative anxiety was equal in the pre-intervention evaluation in both groups (19.76 in the experimental versus 22.02 in the control =22.02; p<0.226), while during the post-intervention, the anxiety score was lower in the intervention group compared with the control group (15.56 and 20.30, respectively; p<0.013). Conclusion. Nursing intervention based on the motivational interview was effective in diminishing preoperative anxiety in patients programmed for knee replacement surgery.


Resumen Objetivo. Determinar la efectividad de una intervención de enfermería basada en la entrevista motivacional, para disminuir la ansiedad preoperatoria en pacientes programados para cirugía de reemplazo de rodilla. Métodos. Ensayo clínico controlado y aleatorizado tipo preventivo, en una muestra de 56 pacientes programados para cirugía de remplazo de rodilla en una clínica en Girardot (Colombia). Se asignaron en forma aleatoria: un grupo de intervención (n=28) y un grupo de control (n=28). Antes y después de la intervención, se aplicó la escala de seis preguntas, APAIS (The Amsterdam Preoperative Anxiety and Information Scale), la cual tiene un puntaje total que va de 5 a 30: a más puntaje, mayor la ansiedad preoperatoria. La intervención de enfermería se desarrolló en 3 sesiones de entrevista motivacional con una duración de 40 minutos, durante las 6 semanas anteriores a la realización del procedimiento quirúrgico. El grupo de control recibió el manejo convencional de educación en la institución de salud. Resultados. La media del puntaje de ansiedad preoperatoria fue igual en la evaluación preintervención en los dos grupos (19.76 en el experimental versus 22.02 en el control = 22.02; p<0.226), mientras que en la posintervención el puntaje de ansiedad fue menor en el grupo de intervención comparado con el grupo control (15.56 y 20.30, respectivamente; p<0.013). Conclusión. La intervención de enfermería basada en la entrevista motivacional fue efectiva en la disminución de la ansiedad preoperatoria en pacientes programados para cirugía de reemplazo de rodilla.


Resumo Objetivo. Determinar a efetividade de uma intervenção de enfermagem baseada na entrevista motivacional, para diminuir a ansiedade pré-operatória em pacientes programados para cirurgia de prótese de joelho. Métodos. Ensaio clínico controlado e aleatorizado tipo preventivo, numa amostra de 56 pacientes programados para cirurgia de prótese de joelho numa clínica em Girardot (Colômbia). Foram designados em forma aleatória: um grupo de intervenção (n=28) e um grupo de controle (n=28). Se aplicou antes e depois da intervenção, a escala de seis perguntas, APAIS (The Amsterdam Preoperative Anxiety and Information Scale), a qual tem uma pontuação total que vá de 5 a 30 a mais pontuação, é maior a ansiedade pré-operatório. A intervenção de enfermagem se desenvolvimento em 3 sessões de entrevista motivacional com uma duração de 40 minutos, durante as 6 semanas anteriores à realização do procedimento cirúrgico; o grupo de controle recebeu o manejo convencional de educação na instituição de saúde. Resultados. A média da pontuação de ansiedade pré-operatória foi igual na avaliação préintervenção nos dois grupos (19.76 no experimental versus 22.02 no controle = 22.02; p<0.226), enquanto que na pós-intervenção a pontuação de ansiedade foi menor no grupo de intervenção comparado com o grupo controle (15.56 e 20.30, respectivamente; p<0.013). Conclusão. A intervenção de enfermagem baseada na entrevista motivacional foi efetiva na diminuição da ansiedade pré-operatória em pacientes programados para cirurgia de prótese de joelho.


Assuntos
Humanos , Ortopedia , Enfermagem Perioperatória , Grupos Controle , Artroplastia do Joelho , Entrevista Motivacional
5.
Work ; 62(4): 629-641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104046

RESUMO

BACKGROUND: A conceptual framework is needed to understand injured workers' decision-making and inform evidence-based interventions to address behavior change regarding return-to-work (RTW). The Model of Human Occupation (MOHO) can help with understanding how an injured worker's characteristics can generate behavior change while Motivational Interviewing (MI) can help facilitate behavior change. OBJECTIVE: This theoretical paper provides an overview of how MOHO and MI can be applied and integrated in occupational rehabilitation. The objectives of this paper are to: (1) evaluate MOHO as a framework for supporting occupational therapists (OTs) in occupational rehabilitation; (2) describe MI as a suitable approach for OTs in occupational rehabilitation; and (3) compare and integrate MOHO and MI. METHOD: Several important works and reviews were used to integrate MOHO and MI with occupational rehabilitation. IMPLICATIONS FOR PRACTICE: The identification of a model and approach to support OT practice in occupational rehabilitation can assist OTs to determine the most appropriate interventions and contribute to standards of best practice. CONCLUSIONS: Integrating MOHO and MI provides a comprehensive framework for understanding impairment and RTW change processes with the potential to reduce work disability and improve RTW outcomes.


Assuntos
Entrevista Motivacional/métodos , Reabilitação Vocacional/métodos , Retorno ao Trabalho/psicologia , Humanos , Entrevista Motivacional/normas , Traumatismos Ocupacionais/complicações , Traumatismos Ocupacionais/psicologia , Terapia Ocupacional/métodos , Reabilitação Vocacional/normas , Indenização aos Trabalhadores/estatística & dados numéricos
6.
Psychol Addict Behav ; 33(4): 349-359, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30958012

RESUMO

To examine the mechanisms underlying the efficacy of a dual-target motivational intervention (MI) to reduce heavy drinking and risky sex. A priori hypotheses were that: increases in alcohol-related readiness to change (RTC) and self-efficacy would mediate the effect of MI on alcohol use; increases in sex-related RTC and self-efficacy would mediate the effect of MI on risky sex; and reductions in alcohol use would mediate reductions in risky sex. Patients in Emergency Departments who screened positive for heavy drinking and risky sex were randomly assigned to receive MI or brief advice. RTC and self-efficacy were assessed at baseline and immediately postintervention. Alcohol use and sexual behavior was assessed at baseline, 3-, 6-, and 9-month follow up. Single- and serial-mediation models were tested. Patients who received MI had higher postintervention RTC and self-efficacy, but neither mechanism mediated the effects of MI on behavioral outcomes. Reduction in heavy drinking mediated the effect of MI on frequency of sex under the influence (SUI). Further, the effect of MI on condomless sex was mediated by an indirect path in which reductions in heavy drinking at 3 months predicted less SUI at 6 months, which in turn predicted reduction in condomless sex at 9-months. Although some effect of dual-target MI on risky sex is independent of drinking, treatment-related reduction in heavy drinking does account for a significant portion of reduction in risky sex, providing support for the utility of this intervention in patient populations where heavy drinking and risky sex co-occur. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Entrevista Motivacional , Autoeficácia , Sexo sem Proteção/prevenção & controle , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sexo sem Proteção/psicologia , Adulto Jovem
9.
J Nurs Educ ; 58(4): 221-224, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30943297

RESUMO

BACKGROUND: The Patient Protection and Affordable Care Act increased numbers of insured individuals and demands for health care cost reductions. A national call for nursing education to focus on health promotion activities exists. Nurse educators can address this shift in health care by including motivational interviewing (MI), a health promotion technique, in the curriculum. METHOD: This exploratory descriptive pilot survey examined postlicensure nursing students' perceptions and self-reported behaviors following an online synchronous telehealth simulation-based experience in which they practiced MI. RESULTS: The survey yielded a 45% (n = 10) response rate. All participants agreed the experience was beneficial to their learning and provided insights on a new clinical practice environment. Eighty percent of participants would have liked to have learned MI in their prelicensure program, and 50% of participants have integrated it in their current practice. CONCLUSION: This tele-health simulation-based experience positively affected the learning and behaviors of postlicensure nursing students. [J Nurs Educ. 2019;58(4):221-224.].


Assuntos
Aprendizagem , Entrevista Motivacional , Treinamento por Simulação/métodos , Estudantes de Enfermagem/psicologia , Telemedicina , Currículo , Educação de Pós-Graduação em Enfermagem/organização & administração , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Projetos Piloto
10.
Rev Prat ; 69(3): e81-e82, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30983270
11.
J Pak Med Assoc ; 69(3): 294-300, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30890817

RESUMO

OBJECTIVE: To evaluate the effect of motivational interviewing on diabetics related to perceived self-management and metabolic variables. METHODS: The randomised controlled and experimental study was conducted at a public hospital located in the city of Gaziantep in Turkey and comprised diabetes patients attending the outpatient clinic of endocrinology and metabolic diseases from April to July 2015. The subjects were randomised into two equal intervention and control groups. Four motivational interviewing sessions, each of which took about 15-20 minutes, were conducted by a nurse to the intervention group. Data was collected using a questionnaire and the Perceived Diabetes Self-Management Scale. RESULTS: Of the 60 subjects, there were 30 (50%) in ach of the two groups. The perceived self-management perception mean score of the intervention group was 17.1 } 5.6 at baseline and increased to 35.0 } 4.1 postintervention (p<0.05). Mean scores of body mass index, fasting and postprandial blood glucose, glycated haemoglobin, cholesterol, triglyceride, low density lipoprotein cholesterol and systolic and diastolic blood pressures of subjects in the intervention group decreased after the intervention, and their high density lipoprotein cholesterol mean scores increased (p<0.05). CONCLUSIONS: Motivational interviewing technique positively affected the metabolic control indicators of the diabetes patients and increased their perceived self-management.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Entrevista Motivacional/métodos , Autogestão/métodos , Adulto , Idoso , Glicemia/metabolismo , Pressão Sanguínea , Colesterol/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Jejum , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Triglicerídeos/metabolismo , Turquia
12.
Psychol Addict Behav ; 33(3): 337-348, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30896192

RESUMO

Problem gamblers tend to adhere to rigid rules about the chances of winning and are resistant to counterfactual information. To promote a more accurate understanding of the odds of scratch-off ticket gambling, we created a brief debiasing intervention consisting of a digital gambling accelerator program that offers demonstrations of the long-term outcomes of gambling. Using a sample of nontreatment seeking scratch-off lottery gamblers recruited from the community (42 subclinical and 45 probable pathological gamblers), we compared the accelerator intervention to brief motivational interviewing (MI) and a control condition. Participants rated their chances of winning, urge to gamble, and readiness to change before and after the interventions. Self-reported dollar amount spent on scratch-off tickets and number of days gambled were assessed at baseline and again at 2- and 4-week follow-ups. Following the active interventions, gamblers in both conditions reported greater readiness to change than controls, and those in the accelerator condition also gave lower ratings of their chances of winning and urge to gamble. Marginal models showed participants in the accelerator condition gambled fewer days at the 2-week follow-up and spent less money at both the 2- and 4-week follow-ups compared to controls; no other between-subjects differences achieved statistical significance. Digital gambling accelerators can impact several clinically relevant domains of gambling and may be useful as stand-alone or adjunct interventions to treat gambling problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Jogo de Azar/psicologia , Entrevista Motivacional , Aprendizagem Baseada em Problemas , Adulto , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Adulto Jovem
13.
J Consult Clin Psychol ; 87(5): 472-483, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30829505

RESUMO

OBJECTIVE: Although a better therapeutic alliance associates with treatment outcome, it may do so in different ways. For example, alliance quality may promote improvement as it shifts over time (within-patient changes); alternatively, alliance quality may also, or instead, influence outcome when generally higher or lower for some patients relative to others (between-patient differences). Although both components have been linked to patient improvement, the distinct mechanisms of these associations have been rarely examined. Conceptually, it follows that within-patient alliance fluctuations (representing the changing nature of a current relationship intended to be ameliorative) may facilitate other interpersonal improvements that could, in turn, translate into symptom reduction. This path squares with the corrective relational experience notion. In contrast, whereas as patients' average alliances across therapy may generally facilitate or hinder improvement, the mechanism may not be other relationship functioning. This squares with the notion that when people generally experience good alliances with their therapist, it may reflect an existing relational ability that catalyzes the effectiveness of other nonrelational therapeutic means. This study tested these distinct hypotheses. METHOD: Patients (N = 85) with generalized anxiety disorder were randomly assigned to cognitive-behavioral therapy, either alone or integrated with motivational interviewing. They rated alliance quality, interpersonal problems, and outcome repeatedly. RESULTS: Using multilevel structural equation modeling, both within- and between-patient alliances related to subsequent worry reduction. As predicted, change in interpersonal problems mediated the association only at the within-patient level. CONCLUSIONS: Results contribute to the literature on mechanisms of the within- and between-person alliance-outcome association. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Relações Interpessoais , Entrevista Motivacional/métodos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Aliança Terapêutica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Drug Alcohol Depend ; 197: 149-157, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30825795

RESUMO

BACKGROUND: Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. METHODS: This study is a secondary analysis of a 4-factor randomized factorial experiment conducted amongst primary care patients (N = 517) presenting for regular healthcare visits in Southern Wisconsin who were unwilling to quit smoking but willing to cut down. We evaluated the main and interactive effects of Motivation-phase intervention components on whether participants: 1) made a quit attempt (intentional abstinence ≥24 h) by 6- and 26-weeks post-study enrollment and, 2) used cessation treatment. We also evaluated the relations of quit attempts with abstinence. The four intervention components evaluated were: 1) Nicotine Patch vs. None; 2) Nicotine Gum vs. None; 3) Motivational Interviewing (MI) vs. None; and 4) Behavioral Reduction Counseling (BR) vs. None. Intervention components were administered over 6 weeks, with an option to repeat treatment; participants could request cessation treatment at any point. RESULTS: Nicotine gum significantly increased the likelihood of making a quit attempt by 6 weeks (23% vs. 15% without gum; p < .05). Conversely, nicotine patch reduced quit attempts when used with BR. Patch also discouraged use of cessation treatment (15.8% vs. 23% without patch; p < .05). Aided vs. unaided quit attempts produced abstinence in 42% vs. 10% of participants, respectively. CONCLUSION: Nicotine gum is a promising Motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.


Assuntos
Entrevista Motivacional/métodos , Goma de Mascar de Nicotina , Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Dispositivos para o Abandono do Uso de Tabaco , Adulto , Aconselhamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Fumar/psicologia , Fumar/terapia , Dispositivos para o Abandono do Uso de Tabaco/tendências , Wisconsin/epidemiologia
15.
J Dent Educ ; 83(5): 585-594, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30858274

RESUMO

Motivational interviewing (MI) is an approach that uses dialogue about behavioral change to encourage a constructive relationship between professionals and patients. The aim of this study was to evaluate the maintenance of basic MI skills in the daily practice of dentists and oral health technicians (OHTs) after a training course and for two years of follow-up in the context of primary health care (PHC). A randomized community trial, from September 2012 to September 2014, was conducted at the Community Health Service of Conceição Hospital Group in Porto Alegre, RS, Brazil. The experimental group consisted of all 41 dentists and OHTs who received an intensive eight-hour training course in basic MI principles; the control group consisted of 31 dentists and OHTs who did not receive MI training. The follow-up assessments were at one and two years using three instruments validated for MI. In the one- and two-year follow-ups, improvement was maintained in responses with a statistically significant difference for use of open questioning, reflective listening, and total percentage of correct answers (p<0.001), with a large effect size (ES=1.12). On the Helpful Responses Questionnaire, the participants continued using open questioning and reflective listening (p<0.001), maintaining an increase in the percentage of responses compatible with MI (p<0.001). Likewise, the effect size remained large (ES=1.33) over time. These results suggest that the training course with dentists and OHTs of the PHC oral health staff was effective over the two-year follow-up in enabling them to act in the spirit and techniques of MI.


Assuntos
Técnicos em Prótese Dentária/educação , Educação em Odontologia , Entrevista Motivacional , Adulto , Odontólogos/estatística & dados numéricos , Educação em Odontologia/métodos , Avaliação Educacional , Feminino , Seguimentos , Humanos , Masculino
16.
Behav Ther ; 50(2): 300-313, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824247

RESUMO

Understanding the role of patient motivation in OCD treatment is of clinical importance given the requisite autonomous role of patients in Exposure and Response Prevention. The present study investigated state- and trait-like relations between three variables: two previously established motivational constructs, readiness to change (RTC) and committed action (CA), derived from the University of Rhode Island Change Assessment, and OCD symptom severity as measured by the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). Utilizing a random-intercept cross-lagged panel model (RI-CLPM) design, we assessed autoregressive, within-time correlations, and cross-lagged effects of RTC, CA, and Y-BOCS-SR scores at admission, month 1 of treatment, and discharge from an intensive/residential treatment program for OCD. Results revealed significant autoregressive (i.e., state-like) effects for CA and Y-BOCS-SR, negative within-time correlations between state CA and Y-BOCS-SR across all time points, a positive within-time correlation between state CA and RTC at admission, and a cross-lagged effect between state Y-BOCS-SR at month 1 of treatment and state RTC at discharge. Results also demonstrated that the stability of the RTC variable was attributable to trait-like factors in the present sample. This study is novel in its use of RI-CLPM in an OCD sample and represents an important addition to the literature on the longitudinal impacts of dynamic constructs of motivation. Our findings may provide future researchers with strategies to supplement ERP with CA-driven motivational interviewing.


Assuntos
Motivação , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Índice de Gravidade de Doença , Adaptação Psicológica/fisiologia , Adulto , Feminino , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Entrevista Motivacional/tendências , Transtorno Obsessivo-Compulsivo/terapia , Autorrelato
17.
Cochrane Database Syst Rev ; 3: CD009660, 2019 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-30883665

RESUMO

BACKGROUND: Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015. OBJECTIVES: To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018. SELECTION CRITERIA: Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list. DATA COLLECTION AND ANALYSIS: We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE. MAIN RESULTS: We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate. AUTHORS' CONCLUSIONS: Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.


Assuntos
Doença Crônica/psicologia , Pais/psicologia , Psicoterapia/métodos , Adolescente , Criança , Pré-Escolar , Terapia Cognitivo-Comportamental , Relações Familiares , Terapia Familiar , Humanos , Lactente , Entrevista Motivacional , Poder Familiar/psicologia , Resolução de Problemas , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
J Neurosci Nurs ; 51(3): 113-118, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30801445

RESUMO

Patients undergoing thoracic or lumbar spine surgery often lack confidence with self-care management of symptoms contributing to disability, such as pain, lack of sleep, depression, and immobility. The purpose of this pilot study was to examine whether a targeted motivational interview, focused on evidence-based recommendations to manage postoperative symptoms related to thoracolumbar spine surgery, would improve patient confidence with self-care management of their symptom-related disability. A quasiexperimental, 1-group, pretest-posttest design was used on a convenience sample of 15 adult surgical spine patients at a large university spine center. Level of disability was measured using the Oswestry Disability Index (ODI). Confidence with self-care management of symptom-related disability was measured using the Health Confidence Index (HCI). Paired samples t tests were completed on participants' preintervention and postintervention scores on the HCI and ODI and on each of the 10 items that the ODI questionnaire addresses. The results of the paired samples t test on participants' HCI scores showed a statistically significant improvement in participants' confidence with self-care management of symptom-related disability from pretest (mean [SD], 6.73 [2.12]) to posttest (mean [SD], 8.73 [1.43]), conditions: t14 = -3.80, P = .002. Motivational interviewing is a beneficial intervention for health professionals to incorporate into practice to encourage the implementation of various health promoting behaviors that improve confidence with self-care management of symptoms in postoperative thoracolumbar spine patients.


Assuntos
Vértebras Lombares/cirurgia , Entrevista Motivacional/métodos , Cuidados Pós-Operatórios/métodos , Autocuidado , Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Inquéritos e Questionários
19.
Compend Contin Educ Dent ; 40(2): 90-96; quiz 97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30767548

RESUMO

For a mother-to-be, pregnancy presents an opportunity to improve not only her health and well being but also that of the immediate family, particularly the newborn infant. The National Consensus Statement of the Oral Health Care During Pregnancy Expert Group together with both governmental and non-governmental guidelines indicate that dental care is both safe and effective during pregnancy. These statements and guidelines may not be widely understood across all healthcare providers that form the perinatal care team, and confusion seems to exist among the general public regarding the safety of and necessity for dental care during pregnancy. Only about half of pregnant patients seek care, even those with dental problems. Previous articles in this series have reviewed appropriateness of dental care during a healthy pregnancy and specific steps to be taken in consideration of the altered physiology brought on by pregnancy and the increased risk associated with oral diseases such as changes in periodontal status, dental caries, and acid erosion; communication through the technique of motivational interviewing with patients who are either planning to become or are pregnant; and collaboration with the perinatal team of providers to ensure improved health outcomes for mother and baby. This final article in the series addresses considerations during and after pregnancy to ensure mother and child may follow a pathway to a future of good oral health.


Assuntos
Assistência Odontológica para Crianças , Assistência Odontológica , Equipe de Assistência ao Paciente , Assistência Perinatal , Criança , Cárie Dentária/prevenção & controle , Feminino , Humanos , Lactente , Entrevista Motivacional , Gravidez , Fatores de Risco
20.
Br J Health Psychol ; 24(2): 334-356, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30793445

RESUMO

PURPOSE: Health interventions based on theory may be more effective than those that are not. This review of reviews synthesizes all published randomized controlled trial (RCT) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective adult health behaviour change interventions. METHODS: Systematic reviews including meta-analyses were identified by searching Medline, CINAHL, PsycINFO, and CDSR. A narrative synthesis was used to summarize and analyse the evidence. Only reviews including RCTs of health behaviour change interventions with adults aged 18+ published from 2007 to 2017 were included. RESULTS: Of 8,659 articles, nine systematic reviews met inclusion criteria. The majority of reviews (n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour. Less than half of the RCTs included in the reviews reported the use of theory (85/183). Two reviews suggested interventions based on control theory, motivational interviewing, or self-determination theory were associated with greater effectiveness for physical activity and/or dietary interventions and outcomes. Methodological and reporting issues limit the conclusions. CONCLUSIONS: Theory-based interventions as currently operationalized in systematic reviews were not found to be more effective than non-theory-based interventions. Methodological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions. The promotion of theory use may benefit from using a multifaceted argument, rather than a narrow focus of increased effectiveness. Statement of contribution What is already known on this subject? Theory use is regularly promoted by claiming that it will lead to more effective behaviour change interventions. Theory use has been frequently linked to effectiveness within systematic reviews of behaviour change interventions. The theory-effectiveness hypothesis has not been systematically examined at the systematic review level. What does this study add? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic reviews examining randomized controlled trials of behaviour change interventions in adults. Interventions based on control theory, motivational interviewing, or self-determination theory were associated with greater effectiveness for physical activity and/or dietary interventions and outcomes. Theory use should be promoted using a multifaceted argument, and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this claim.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Revisão Sistemática como Assunto , Adulto , Humanos , Entrevista Motivacional , Ensaios Clínicos Controlados Aleatórios como Assunto
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