Translational Behavioral Medicine最新文献

Background: Afterschool "aftercare" programs (ASPs) have been recognized as critical settings to promote youth adequate daily physical activity (PA). However, several social and contextual challenges, especially faced by ASPs serving under-resourced schools/communities, inhibit youth from meeting PA goals, with the COVID-19 pandemic only exacerbating these challenges. Connect through PLAY (CTPI) is a 16-week social-motivational PA intervention designed to increase PA in underserved youth (ages 9-16) by providing staff training and resources to overcome social-contextual challenges and integrate youth social-motivational needs into the PA programming of existing ASPs.

Purpose: This study aimed to evaluate the feasibility of translating the CTPI intervention into a virtual format during the onset of the COVID-19 pandemic. To date, we know little about whether establishing a positive social-motivational climate is possible through a virtual format.

Methods: The intervention included three components: (i) a novel PA curriculum, (ii) small group sessions, and (iii) staff health initiative. Youth and staff surveys were collected at baseline and endpoint to assess integration, acceptability, and potential effectiveness (longitudinal subsample n = 27 youth; 37% female; 36.1% Black/African American; Mage = 9.96 years).

Results: Paired sample t-tests indicated significant improvements in youth PA interest, cognitive engagement, regulatory motives, and PA participation, with medium to large effect sizes. Staff reported high acceptability and enthusiasm for continuing the intervention's virtual activities.

Conclusion: Findings demonstrate that PA interventions focused on cultivating a positive social-motivational climate can be successfully adapted to virtual formats, providing valuable health promotion opportunities with greater reach to youth within under-resourced communities.

Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial. A mixed-methods approach informed by the Consolidated Framework for Implementation Research (CFIR) examined barriers and facilitators to AH-HA implementation in four NCI Community Oncology Research Program (NCORP) practices participating in the WF-1804CD AH-HA trial. Provider surveys were analyzed using descriptive statistics. Interviews with providers (n = 15) were coded using deductive (CFIR) and inductive codes by trained analysts. The CFIR rating tool was used to rate each quote for (i) valence, defined as a positive (+) or negative (-) influence, and (ii) strength, defined as a neutral (0), weak (1), or strong (2) influence on implementation. All providers considered discussing cardiovascular health with patients as important (61.5%, n = 8/13) or somewhat important (38.5%, n = 5/13). The tool was well-received by providers and was feasible to use in routine care among cancer survivors. Providers felt the tool was acceptable and usable, had a relative advantage over routine care, and had the potential to generate benefits for patients. Common reasons clinicians reported not using AH-HA were (i) insufficient time and (ii) the tool interfering with workflow. Systematically identifying implementation determinants from this study will guide the broader dissemination of the AH-HA tool across clinical settings and inform implementation strategies for future scale-up hybrid trials.

Millions of children across the United States rely on school meals as a primary source of daily nutrition. Access to healthy meals improves diet quality, reduces hunger, and supports better attendance and academic performance. Recent federal actions, however, have threatened the reach and quality of these programs. Funding reductions have limited schools' ability to purchase fresh, locally sourced foods and have made universal free meals harder to provide. These changes disproportionately affect students from low-income and historically marginalized communities, increasing food insecurity, stigma, and meal debt. The Society of Behavioral Medicine (SBM) urges Congress to restore funding for the Local Food for Schools and Local Food Purchase Assistance programs, which help schools and food banks provide fresh, locally produced foods. We also call on lawmakers to co-sponsor the No Hungry Kids in Schools Act to expand universal free meal access and simplify eligibility requirements. Finally, SBM recommends codifying the key nutrition standards from the Healthy, Hunger-Free Kids Act into law to protect them from administrative or political changes. These measures would ensure reliable nutrition for all students, reduce hunger and meal debt, support local agriculture, and promote equity. Strengthening school meal programs is an evidence-based strategy to improve child health, enhance academic outcomes, and support social and educational equity nationwide.

Background: Cannabis policy is a complex and rapidly evolving topic with significant implications for behavioral and public health. Behavioral and public health professionals have an opportunity to identify emerging problems, engage with communities to identify solutions and work to educate and guide policymakers to support cannabis policies that benefit public health. However, little is known about their engagement in cannabis policy.

Methods: A 2023 survey assessed barriers to community engagement on cannabis policy among a broad sample of behavioral and public health professionals throughout California. Professionals in behavioral health, substance use, public health, tobacco control, and youth prevention were invited.

Results: Responses were received from 246 people (44% response rate) working in three main sectors (50% nonprofit, 34% government, and 13% health care) and each of California's 58 counties. Seventy percent of respondents reported they were interested in being involved in cannabis regulation. However, only 34% had ever worked in cannabis policy. They encountered structural barriers: restrictions on lobbying (38%), funding availability (38%), and staff time (34%). They also reported motivational barriers: few had confidence working on specific cannabis policy issues, including taxation policies (20%) and restricting intoxicating hemp products (29%); few were comfortable with certain community engagement activities, such as writing laws or policies (20%) or preparing written comments on proposed laws (31%). They reported their engagement would benefit most from additional financial resources (70%), training (59%), political support (48%), model laws (42%), and technical assistance (40%).

Conclusion: Behavioral and public health professionals have limited experience with engagement in cannabis policy issues. They face structural and motivational barriers. They need dedicated resources and support for their work. These findings may be relevant to advancing community engagement in cannabis in other states and countries.

Background: Digital health (DH) technologies provide scalable and cost-effective solutions to improve population health but face challenges of uneven adoption and high attrition, particularly among vulnerable and minority groups.

Purpose: This study explores factors influencing DH adoption in a multicultural population and identifies strategies to improve equitable access.

Methods: Using a Patient and Public Involvement approach, lay facilitators engaged adults at public eateries in Singapore to discuss motivations and barriers to DH adoption. A semi-structured guide facilitated discussions, followed by an optional socio-demographic survey. Data were analyzed through inductive thematic analysis and mapped to behavior change theory to identify mechanisms of action (MoA) and behavior change techniques (BCTs) to support adoption.

Results: Facilitators engaged 118 participants between November 2022 and February 2023. Five key themes were identified from the discussions: (a) awareness of DH solutions, (b) weighing benefits against burdens, (c) accessibility, (d) trust in DH developers and technology, and (e) the impact of user experience. These themes were mapped to 13 MoA and 26 BCTs, informing five key strategies to enhance DH adoption: community-based promotion of credible DH solutions and digital literacy training, brief counselling at opportune moments in healthcare settings, variable rewards tied to personal values, policies ensuring accessibility and regulation, and gamified, user-friendly designs emphasizing feedback and behavioral cues.

Conclusion: Designing and implementing DH solutions that are accessible, trustworthy, and motivating-integrated within healthcare services and promoted through community efforts-can address barriers to adoption by diverse communities and may help to narrow the digital divide.

Background: The Supplemental Nutrition Assistance Program (SNAP) is an underutilized program. SNAP uptake is limited in Latine households in particular due to concerns about immigration eligibility, even when there are SNAP-eligible household members. Implementation strategies are urgently needed to increase SNAP participation rates among those who are eligible.

Purpose: We used collaborative planning and implementation mapping to design implementation strategies to increase SNAP participation.

Methods: Collaborative planning and implementation mapping included: (i) identify a shared priority; (ii) review relevant data to identify determinants of SNAP participation; (iii) design strategies to accomplish the priority goal; (iv) reach consensus and pilot-chosen strategies and workflows; and (v) evaluate implementation success based on chosen outcomes. Using the Practical Robust Implementation and Sustainability Model, we identified two implementation strategies, a community and a policy strategy, to pilot from January to December 2023.

Results: The community strategy leveraged an existing food program to identify participants who were not already enrolled in SNAP. This resulted in 69 referrals and 4 new SNAP enrollees. The policy strategy leveraged the existing policy context to link SNAP enrollment with Medicaid insurance reenrollment at the end of the COVID-19 public health emergency protections. This resulted in an unknown number of referrals due to data workflow barriers.

Conclusions: Despite considering context in the design and piloting of two implementation strategies, success was limited. Future success will require including the perspectives of those with lived experience to inform processes to identify eligible individuals without creating additional stigma or furthering distrust among those who may be ineligible.

The purpose of this study was to Produce prescription (PPR) programs aim to improve fruit and vegetable (FV) access and health outcomes by providing FVs and nutrition education to participants with low income. While PPRs show promise in increasing FV intake and reducing food insecurity, more research is needed to understand effective implementation. To determine how PPRs work in different settings, and to describe implementation characteristics. In-depth interviews were conducted with PPR project implementers using a semi-structured guide based on the Consolidated Framework for Implementation Research (CFIR). PPR sites were selected through maximum variation and interviewees at each site were selected using snowball sampling. Interviews were recorded, transcribed, and coded using NVivo software using a deductive codebook, with two researchers coding each interview. Interviewees included 33 individuals across 13 PPR projects. The analysis identified themes across CFIR constructs: (i) project characteristics (e.g. eligibility, nutrition education, adaptations to local context, relative advantage, cost), (ii) characteristics of individuals (e.g. participants, food retailers, healthcare staff, role delineation, networks), (iii) evidence (e.g. economic impact, FV Intake, household food security and health-related outcomes, scope and impact), (iv) implementation climate (e.g. project genesis, alignment with organization values, leadership engagement, geography, technology), and (v) challenges (e.g. COVID-19 impacts, capacity limitations). Interviewees also provided recommendations for resources that would be helpful in their PPR implementation, such as "plug and play" materials to reduce setup burden. This study highlights PPR implementation characteristics, which can elucidate which features may be most effective in particular contexts. There was also an identified need for further investigation into fostering healthcare organization buy-in and engagement.

Background: Cultural adaptation of evidence-based interventions (EBIs) enhances accessibility and promotes engagement and uptake within diverse communities. However, one of the challenges of culturally adapting interventions is the time required, particularly for collecting and analyzing qualitative data that may inform the adaptations.

Purpose: To describe a new rapid analysis framework to identify the topics, content and adaptations that should be considered when culturally adapting EBIs.

Methods: We describe the Community-Engaged Rapid Analysis and Visualization (CARV) methodological framework used for conducting a rapid cultural adaptation of an EBI.

Results: The application of CARV to culturally adapting OurRelationship-an evidence-based, online psychosocial education intervention-for Latina breast cancer survivors and their romantic partners. We highlight how this team-based approach enabled timely cultural adaptation while preserving rigor and the iterative nature of qualitative analysis, offering a time-efficient alternative to more traditional qualitative methods.

Conclusions: The step-by-step approach outlined here is a practical guide for researchers interested in culturally adapting EBIs.

Chronic stress undermines psychological and physiological health. We tested three remotely delivered stress management interventions among clergy, accounting for intervention preferences. United Methodist clergy in North Carolina enrolled in a partially randomized, preference-based waitlist control trial. The interventions were: mindfulness-based stress reduction (MBSR), Daily Examen prayer practice, and Stress Proofing (stress inoculation plus breathing skills). Co-primary outcomes were symptoms of stress (Calgary Symptoms of Stress Inventory) and 48-hour ambulatory heart rate variability (HRV) at 12 weeks compared to waitlist control. Survey data were collected at 0, 12, and 24 weeks and 48-hour ambulatory HRV at 0 and 12 weeks. The 255 participants were 91% White and 48% female. Forty-nine participants (22%) without a preference were randomly assigned between the three interventions (n = 40) and waitlist control (n = 9). Two hundred six participants (78%) with a preference were randomly assigned to waitlist control (n = 62) or their preferred intervention (n = 144). Compared to waitlist control, MBSR [mean difference (MD) = -0.30, 95% CI: -0.41, -0.20; P < .001] and Stress Proofing (MD = -0.27, 95% CI: -0.40, -0.14; P < .001) participants had lower stress symptoms at 12 weeks; Daily Examen participants did not until 24 weeks (MD = -0.24, 95% CI: -0.41, -0.08). MBSR participants demonstrated improvement in HRV at 12 weeks (MD = +3.32 ms; 95% CI: 0.21, 6.44; P = .036). MBSR demonstrated robust improvement in self-reported and objective physical correlates of stress; Stress Proofing and Daily Examen resulted in improvements in self-reported correlates of stress. These brief practices were sustainable and beneficial for United Methodist clergy during the heightened stressors of the COVID pandemic. ClinicalTrials.gov identifier: NCT04625777.

Background: African American individuals experience disparities in the burden of lung cancer compared to other racial or ethnic groups. Yet, African Americans are less likely than White patients to have provider-initiated discussions about lung cancer screening (LCS). In addition to provider-level barriers, predictors of racial disparities include patient-level knowledge barriers and medical mistrust. This study assessed the feasibility and acceptability of provider- and patient-oriented approaches to increase uptake of LCS in a majority African American primary care clinic setting.

Methods: In Phase 1, we conducted surveys (N = 22) and usability testing with providers (N = 7) to develop a previsit planning message, a type of clinician reminder. The clinician reminder is sent via the electronic health record ahead of scheduled visits with screening-eligible participants to promote LCS discussion. We partnered with a primary care clinic (N = 5 providers; N = 399 patients 50-80 years old with a documented smoking history, no prior lung cancer diagnosis) to evaluate the impact of the reminder on LCS referral rates. In Phase 2, we conducted a pretest-posttest study (N = 16) to pilot a previsit phone-based patient education session. Patient-level LCS knowledge was assessed using 10 true/false items and a single item measured screening intentions.

Results: In Phase 1, LCS referrals increased from 6 6-months prepilot to 49 during the 6-month pilot period. The majority (89.8%) of the orders placed had a clinician reminder. In Phase 2, from pretest to posttest, there was improvement in LCS knowledge (mean percent correct: 63.3% to 76.7%; P = .013) and screening intentions (43.8% to 82%; P = .05).

Conclusions: In a diverse clinical setting, we developed a feasible and acceptable multilevel approach aimed at increasing LCS equitably.

Clinical trial information: The Clinical Trials Registration #NCT04675476.