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Størksen HT, Haga SM, Hammerstrøm KT, Jacobsen H, Drozd F. Internet-based interventions for parents with children 0-5 years: A scoping review. Acta Paediatr 2023; 112:897-910. [PMID: 36269088 DOI: 10.1111/apa.16569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/13/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
AIM This study aims to review the existing literature on Internet-based health interventions directed to support parents of children aged 0-5 years. METHODS We systematically searched electronic databases between January 2000 and 2018. The search consisted of terms describing eHealth, intervention and families and/or children. RESULTS Internet-based parent support interventions were most often directed at rehabilitation and selective prevention, and we identified more studies on mental health (57%) than somatic health (41%). Developmental disorders were the most frequently studied mental health condition (n = 33), while interventions for obesity (15%) were the most studied somatic health condition. Forty-four percent of mental health studies were RCTs and 65% of interventions were theory driven. Interventions most often used a behavioural approach, included guidance and delivered content via text-based information. CONCLUSION Several significant gaps were identified such as the need for more research outside of English-speaking countries, more systematic reviews and effect studies. This review also elucidates the need for researchers to improve reporting on the theoretical approaches employed in interventions, and to focus on determining the importance of guidance. Finally, program developers should consider using more audio-visual technology to avoid reinforcing social inequalities in access to healthcare.
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Affiliation(s)
- Hege Therese Størksen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | | | - Heidi Jacobsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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McDaniel CC, Kavookjian J, Whitley HP. Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2022; 105:805-820. [PMID: 34366228 PMCID: PMC8912910 DOI: 10.1016/j.pec.2021.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The objective of this systematic review was to explore and report the evidence and gaps in the literature for randomized controlled trials (RCTs) studying the effects of motivational interviewing (MI)-based telehealth interventions on outcomes among persons with diabetes (PWD) or prediabetes. METHODS Following a modified Cochrane approach, we searched Pubmed, CENTRAL, CINAHL, PsycINFO, and Clinicaltrials.gov. Included studies were RCTs published in English before March 25, 2021 evaluating MI-based telehealth on outcomes for adults with diabetes or prediabetes. RESULTS A total of 21 retained articles captured results for 6436 PWD. Among the most commonly investigated outcomes, 60% of articles documented A1C reductions (ranging from<1% to>3%), 56% documented systolic blood pressure reductions, 57% documented diabetes self-efficacy/empowerment improvements, and 40% documented physical activity improvements. Conversely, diastolic blood pressure, lipid panels, body mass index, depressive symptoms, and quality of life were frequently measured outcomes, where MI-based telehealth yielded minor effects (<30% of articles demonstrating improvements). CONCLUSIONS MI-based telehealth seems most effective for improving A1C, systolic blood pressure, diabetes self-efficacy, and physical activity behaviors. Variability in outcome assessment and intervention heterogeneity were key challenges impeding comparisons across retained articles. PRACTICE IMPLICATIONS MI-based telehealth interventions demonstrate promising results for improving outcomes in PWD.
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Affiliation(s)
- Cassidi C McDaniel
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
| | - Jan Kavookjian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Heather P Whitley
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
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3
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Gupta M, Ramar D, Vijayan R, Gupta N. Artificial Intelligence Tools for Suicide Prevention in Adolescents
and Young Adults. ADOLESCENT PSYCHIATRY 2022; 12:1-10. [DOI: 10.2174/2210676612666220408095913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
Abstract
Background:
Artificial Intelligence is making a significant
transformation in human lives. Its application in the medical and healthcare field
has also been observed to make an impact and improve overall outcomes. There has
been a quest for similar processes in mental health due to the lack of observable
changes in the areas of suicide prevention. In the last five years, there has been an
emerging body of empirical research applying the technology of artificial
intelligence (AI) and machine learning (ML) in mental health.
Objective:
To review the clinical applicability of the AI/ML-based tools in suicide
prevention.
Methods:
The compelling question of predicting suicidality has been the focus of
this research. We performed a broad literature search and then identified 36 articles
relevant to meet the objectives of this review. We review the available evidence and
provide a brief overview of the advances in this field.
Conclusion:
In the last five years, there has been more evidence supporting the
implementation of these algorithms in clinical practice. Its current clinical utility is
limited to using electronic health records and could be highly effective in
conjunction with existing tools for suicide prevention. Other potential sources of
relevant data include smart devices and social network sites. There are some serious
questions about data privacy and ethics which need more attention while
developing these new modalities in suicide research.
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Affiliation(s)
- Mayank Gupta
- Clarion Psychiatric Center, Clarion, PA 16214, USA
| | - Dhanvendran Ramar
- Bellin Health Psychiatric Clinical
Services, & Medical College of Wisconsin Green Bay Wisconsin 54301, USA
| | - Rekha Vijayan
- Bellin Health Psychiatric Clinical
Services, & Medical College of Wisconsin Green Bay Wisconsin 54301, USA
| | - Nihit Gupta
- University of West
Virginia, Reynolds Memorial Hospital, Glendale WV 26038, USA
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Hohman M, McMaster F, Woodruff SI. Contact Tracing for COVID-19: The Use of Motivational Interviewing and the Role of Social Work. CLINICAL SOCIAL WORK JOURNAL 2021; 49:419-428. [PMID: 33776159 PMCID: PMC7982339 DOI: 10.1007/s10615-021-00802-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 05/11/2023]
Abstract
One method in mitigating the impact of COVID-19 is that of contact tracing. It is estimated that in the US, 35,000-100,000 contact tracers will be hired (and trained) to talk to recently-infected individuals, understand who they have exposed to the virus, and encourage those exposed to self-quarantine. The Center for Disease Control recommends the use of motivational interviewing (MI) by contact tracers to encourage compliance with contact tracing/quarantine. Contact tracers need to sensitively communicate with COVID-19-exposed individuals who may also be experiencing other issues caused by the pandemic, such as anxiety, depression, grief, anger, intimate partner violence, health problems, food insecurity, and/or unemployment. Social workers are particularly prepared to address the mental health and other psychosocial problems that may be encountered in the tracing process. This article describes contact tracing, its use in other diseases, the role of MI, psychosocial issues that contact tracers may encounter, and how social work can respond to these needs. A sample dialogue of contact tracing using MI is presented with a discussion of the content and skills used in the process.
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Affiliation(s)
- Melinda Hohman
- School of Social Work, San Diego State University, San Diego, CA USA
- 24645 Kings Pointe, Laguna Niguel, CA 92677 USA
| | | | - Susan I. Woodruff
- School of Social Work, San Diego State University, San Diego, CA USA
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Huffman JC, Golden J, Massey CN, Feig EH, Chung WJ, Millstein RA, Brown L, Gianangelo T, Healy BC, Wexler DJ, Park ER, Celano CM. A positive psychology-motivational interviewing program to promote physical activity in type 2 diabetes: The BEHOLD-16 pilot randomized trial. Gen Hosp Psychiatry 2021; 68:65-73. [PMID: 33338737 PMCID: PMC8307449 DOI: 10.1016/j.genhosppsych.2020.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The majority of persons with type 2 diabetes (T2D) do not meet recommended levels of physical activity, despite clear links between physical activity and superior medical outcomes in this population. The objective of this trial was to assess the feasibility and impact of a novel 16-week combined positive psychology-motivational interviewing (PP-MI) program to promote physical activity among inactive persons with T2D. METHODS This pilot randomized trial compared the 16-week, phone-delivered PP-MI intervention to an attention-matched diabetes counseling condition among 70 persons with T2D and low levels of baseline moderate to vigorous physical activity (MVPA; <150 min/week). The primary study outcomes were feasibility (assessed via rates of session completion) and acceptability (assessed via mean participant ratings [0-10] of the ease and utility of weekly sessions). Key secondary outcomes included between-group differences in improvement in positive affect, other psychological outcomes, and accelerometer-measured physical activity, assessed using mixed effects regression models, at 16 and 24 weeks. RESULTS Participants completed a mean 11.0 (SD 4.4; 79%) of 14 PP-MI phone sessions, and composite mean ratings of ease/utility were 8.6/10, above our a priori benchmarks for feasibility/acceptability (70% session completion; 7.0/10 mean ratings). PP-MI participants had small to medium effect size (ES) difference improvements in MVPA (ES difference = 0.34) and steps/day (ES difference = 0.76) at 16 weeks, with sustained but smaller effects at 24 weeks (ES difference = 0.22-0.33). CONCLUSIONS Next-step studies of this PP-MI program in T2D patients can more rigorously explore the intervention's effects on physical activity and clinical outcomes.
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Affiliation(s)
- Jeff C Huffman
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Julia Golden
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christina N Massey
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Emily H Feig
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Wei-Jean Chung
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel A Millstein
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lydia Brown
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Taylor Gianangelo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J Wexler
- Harvard Medical School, Boston, MA, USA; Department of Medicine (Endocrinology), Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R Park
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M Celano
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Zambrano J, Celano CM, Chung WJ, Massey CN, Feig EH, Millstein RA, Healy BC, Wexler DJ, Park ER, Golden J, Huffman JC. Exploring the feasibility and impact of positive psychology-motivational interviewing interventions to promote positive affect and physical activity in type 2 diabetes: design and methods from the BEHOLD-8 and BEHOLD-16 clinical trials. Health Psychol Behav Med 2020; 8:398-422. [PMID: 33763296 PMCID: PMC7986224 DOI: 10.1080/21642850.2020.1815538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Physical activity among those with type 2 diabetes (T2D) is independently associated with superior medical outcomes, but existing behavioral interventions have not led to widespread increases in activity in this population. A remotely delivered intervention that targets well-being constructs associated with greater activity and assists in the creation of specific physical activity goals has the potential to improve activity and outcomes in T2D. OBJECTIVE To outline the rationale and methods of two studies designed to assess the impact and optimal duration of a combined positive psychology-motivational interviewing (PP-MI) intervention for inactive persons with T2D. METHODS We conducted trials studying 8-week (BEHOLD-8;) and 16-week (BEHOLD-16;) phone-delivered interventions, compared to attention-matched control conditions. In a two-step randomization design, participants were allocated randomly first to study (BEHOLD-8 or BEHOLD-16), then to study condition within study. The primary aims in both trials were feasibility (rates of session completion) and acceptability (participant session ratings), with additional aims examining intervention effects on accelerometer-measured physical activity, psychological measures, and health-related metrics (e.g. vital signs). Main analyses, currently being conducted, will utilize mixed effects models between study conditions, and secondary analyses will utilize the same models to compare the 8- and 16-week PP-MI interventions on feasibility and impact. RESULTS Enrollment and data collection have been completed for both trials (BEHOLD-8: N = 60; BEHOLD-16: N = 70), and data analysis is ongoing to assess feasibility and acceptability within study, as well as the relative feasibility and acceptability of the PP-MI interventions across the two studies. We will also explore impact on clinical outcomes between groups. CONCLUSIONS This design will address how intervention content (i.e. PP elements vs. no PP elements) and intervention duration (8 weeks vs. 16 weeks) affect feasibility, acceptability, and impact, allowing intervention optimization before a next-step larger clinical trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03150199; NCT03001999.
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Affiliation(s)
- Juliana Zambrano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Wei-Jean Chung
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christina N. Massey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily H. Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel A. Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian C. Healy
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J. Wexler
- Harvard Medical School, Boston, MA, USA
- Department of Medicine (Endocrinology), Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R. Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Julia Golden
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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A Positive Psychology-Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity in Type 2 Diabetes: The BEHOLD-8 Controlled Clinical Trial. Psychosom Med 2020; 82:641-649. [PMID: 32665479 PMCID: PMC7676457 DOI: 10.1097/psy.0000000000000840] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Physical activity is associated with superior health outcomes in patients with type 2 diabetes (T2D), but most T2D patients do not follow physical activity recommendations. The objective of this study was to assess the feasibility and impact of a novel combined positive psychology-motivational interviewing (PP-MI) intervention to promote physical activity in T2D. METHODS This controlled clinical trial compared an 8-week, phone-delivered PP-MI intervention to an attention-matched MI-enhanced behavioral counseling condition among 60 participants with T2D and suboptimal moderate to vigorous physical activity (MVPA; <150 min/wk). The primary study outcome was feasibility (proportion of sessions completed) and acceptability (0-10 ease and utility ratings of each session). Secondary outcomes were between-group differences in changes in positive affect (main psychological outcome) and accelerometer-measured physical activity (MVPA and steps per day), using mixed-effects regression models, at 8 and 16 weeks. RESULTS Ninety-two percent of PP-MI sessions were completed, and mean participant ratings of ease/utility were 8.5 to 8.8/10, surpassing a priori benchmarks for feasibility and acceptability. PP-MI participants had small-medium effect size (ES) difference improvements in positive affect compared with MI (8 weeks: estimated mean difference [EMD] = 3.07 [SE = 1.41], p = .029, ES = 0.44; 16 weeks: EMD = 2.92 [SE = 1.73], p = .092, ES = 0.42). PP-MI participants also had greater improvements in MVPA (8 weeks: EMD = 13.05 min/d [SE = 5.00], p = .009, ES = 1.24; 16 weeks: EMD = 7.96 [SE = 4.53], p = .079, ES = 0.75), with similar improvements in steps per day. CONCLUSIONS The PP-MI intervention was feasible and well accepted. Next-step efficacy studies can more rigorously explore the intervention's effects on physical activity and clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Registration No. NCT03150199.
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Evaluating the efficacy of the Family Check-Up Online: A school-based, eHealth model for the prevention of problem behavior during the middle school years. Dev Psychopathol 2020; 31:1873-1886. [PMID: 31407644 PMCID: PMC10077819 DOI: 10.1017/s0954579419000907] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluated the efficacy of a family-centered preventive intervention, the Family Check-Up (FCU), delivered as an online, eHealth model to middle school families. To increase accessibility of family-centered prevention in schools, we adapted the evidence-based FCU to an online format, with the goal of providing a model of service delivery that is feasible, given limited staffing and resources in many schools. Building on prior research, we randomly assigned participants to waitlist control (n = 105), FCU Online as a web-based intervention (n = 109), and FCU Online with coaching support (n = 108). We tested the effects of the intervention on multiple outcomes, including parental self-efficacy, child self-regulation, and child behavior, in this registered clinical trial (NCT03060291). Families engaged in the intervention at a high rate (72% completed the FCU assessment) and completed 3-month posttest assessments with good retention (94% retained). Random assignment to the FCU Online with coaching support was associated with reduced emotional problems for children (p = .003, d = -0.32) and improved parental confidence and self-efficacy (p = .018, d = 0.25) when compared with waitlist controls. Risk moderated effects: at-risk youth showed stronger effects than did those with minimal risk. The results have implications for online delivery of family-centered interventions in schools.
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Mesters I, Keulen HMV, de Vries H, Brug J. Counselor competence for telephone Motivation Interviewing addressing lifestyle change among Dutch older adults. EVALUATION AND PROGRAM PLANNING 2017; 65:47-53. [PMID: 28697374 DOI: 10.1016/j.evalprogplan.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 05/23/2017] [Accepted: 06/19/2017] [Indexed: 05/11/2023]
Abstract
Counselor competence in telephone Motivation Interviewing (MI) to change lifestyle behaviors in a primary care population was assessed using the Motivational Interviewing Treatment Integrity (MITI) rating system. Counselor behavior was evaluated by trained raters. Twenty minutes of a random sample of 336 MI sessions were coded representing 232 counselees. Ninety-four sessions (28%) were double coded to assess inter-rater agreement. The MI fidelity was examined by comparing the MI fidelity scores direction, empathy, spirit, % open questions, % complex reflections, reflections-to-questions ratio, % MI-adherent responses with the matching beginner proficiency MITI threshold. The inter-rater agreements for the MI fidelity summary scores were good (spirit, reflections-to-questions ratio), fair (empathy, % open questions, % MI-adherent responses) or poor (direction, % complex reflection). The MI fidelity scores for direction, empathy, spirit and the percentage of complex reflections exceeded the MITI threshold, but lower scores were found for the percentage of open questions, the reflections-to-questions ratio and the percentage of MI-adherent responses. In conclusion, evidence that MI was implemented was revealed. However, the inter-rater agreements scores and some fidelity scores leave room for improvement indicating that raters and counselors may need more ongoing training and feedback to achieve and maintain adequate competence. These findings apply to more complex skills (as rating complex reflections) in particular.
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Affiliation(s)
- Ilse Mesters
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Hilde M van Keulen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; TNO, The Hague, The Netherlands.
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Center Amsterdam, Postbus 7057, 1007 MB Amsterdam, The Netherlands.
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Cox DJ, Gonder-Frederick LA, Singh H, Ingersoll KS, Banton T, Grabman JH, Schmidt K, Clarke W. Predicting and Reducing Driving Mishaps Among Drivers With Type 1 Diabetes. Diabetes Care 2017; 40:742-750. [PMID: 28404657 PMCID: PMC5439415 DOI: 10.2337/dc16-0995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/18/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Two aims of this study were to develop and validate A) a metric to identify drivers with type 1 diabetes at high risk of future driving mishaps and B) an online intervention to reduce mishaps among high-risk drivers. RESEARCH DESIGN AND METHODS To achieve aim A, in study 1, 371 drivers with type 1 diabetes from three U.S. regions completed a series of established questionnaires about diabetes and driving. They recorded their driving mishaps over the next 12 months. Questionnaire items that uniquely discriminated drivers who did and did not have subsequent driving mishaps were assembled into the Risk Assessment of Diabetic Drivers (RADD) scale. In study 2, 1,737 drivers with type 1 diabetes from all 50 states completed the RADD online. Among these, 118 low-risk (LR) and 372 high-risk (HR) drivers qualified for and consented to participate in a 2-month treatment period followed by 12 monthly recordings of driving mishaps. To address aim B, HR participants were randomized to receive either routine care (RC) or the online intervention "DiabetesDriving.com" (DD.com). Half of the DD.com participants received a motivational interview (MI) at the beginning and end of the treatment period to boost participation and efficacy. All of the LR participants were assigned to RC. In both studies, the primary outcome variable was driving mishaps. RESULTS Related to aim A, in study 1, the RADD demonstrated 61% sensitivity and 75% specificity. Participants in the upper third of the RADD distribution (HR), compared with those in the lower third (LR), reported 3.03 vs. 0.87 mishaps/driver/year, respectively (P < 0.001). In study 2, HR and LR participants receiving RC reported 4.3 and 1.6 mishaps/driver/year, respectively (P < 0.001). Related to aim B, in study 2, MIs did not enhance participation or efficacy, so the DD.com and DD.com + MI groups were combined. DD.com participants reported fewer hypoglycemia-related driving mishaps than HR participants receiving RC (P = 0.01), but more than LR participants receiving RC, reducing the difference between the HR and LR participants receiving RC by 63%. HR drivers differed from LR drivers at baseline across a variety of hypoglycemia and driving parameters. CONCLUSIONS The RADD identified higher-risk drivers, and identification seemed relatively stable across time, samples, and procedures. This 11-item questionnaire could inform patients at higher risk, and their clinicians, that they should take preventive steps to reduce driving mishaps, which was accomplished in aim B using DD.com.
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Affiliation(s)
- Daniel J Cox
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Harsimran Singh
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Tom Banton
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jesse H Grabman
- University of Virginia School of Medicine, Charlottesville, VA
| | - Karen Schmidt
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - William Clarke
- University of Virginia School of Medicine, Charlottesville, VA
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Kaar JL, Luberto CM, Campbell KA, Huffman JC. Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults. World J Cardiol 2017; 9:396-406. [PMID: 28603586 PMCID: PMC5442407 DOI: 10.4330/wjc.v9.i5.396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.
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Östlund AS, Kristofferzon ML, Häggström E, Wadensten B. Primary care nurses' performance in motivational interviewing: a quantitative descriptive study. BMC FAMILY PRACTICE 2015. [PMID: 26205692 PMCID: PMC4513379 DOI: 10.1186/s12875-015-0304-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing. Method The study was based on twelve primary care nurses’ audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1. Results None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in “percent open questions” was the summary score that fewest achieved. Conclusion Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.
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Affiliation(s)
- Ann-Sofi Östlund
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, Uppsala, 751 22, Sweden. .,Faculty of Health and Occupational Studies, University of Gävle, Gävle, 801 76, Sweden.
| | - Marja-Leena Kristofferzon
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, Uppsala, 751 22, Sweden. .,Faculty of Health and Occupational Studies, University of Gävle, Gävle, 801 76, Sweden.
| | - Elisabeth Häggström
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, Uppsala, 751 22, Sweden. .,Faculty of Health and Occupational Studies, University of Gävle, Gävle, 801 76, Sweden.
| | - Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, Uppsala, 751 22, Sweden.
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