Translational Behavioral Medicine最新文献

Background: Leaders of healthcare organizations are often called on to guide the implementation of new innovations, including evidence-based practices and digital health technologies. However, many leaders lack preparation for this role and most available leadership trainings have not been rigorously tested, particularly over periods incorporating multiple implementation phases.

Purpose: This study tested the effects of the Leadership and Organizational Change for Implementation (LOCI) strategy on the uptake of digital measurement-based care (MBC) in mental health settings across 35 months, incorporating implementation and sustainment phases.

Methods: In 21 outpatient mental health clinics serving youth, a two-arm, cluster randomized, hybrid type III effectiveness-implementation trial tested whether adding LOCI (k = 11) to standard digital MBC training and technical assistance (k = 10) improved uptake of digital MBC, assessed using system generated data and operationalized as clinic-level monthly counts of the number of youths with a measure administered and with feedback viewed by their clinician.

Results: On both outcomes, clinics randomized to LOCI exhibited superior initial uptake (3 months post-baseline: mean difference in youths with measure administered per clinic (MYMA_Diff=5.09, 95% CI=[1.63-8.55]); mean difference in youths with feedback viewed per clinic (MYFV_Diff=3.81 [1.26-6.37]), superior uptake when the implementation phase concluded (13 months post-baseline: MYMA_Diff=9.03, [1.64-16.41]; MYFV_Diff=8.31 [3.07-13.56]), and superior uptake when the sustainment phase concluded (35 months post-baseline: MYMA_Diff=3.82 [1.28-6.36]; MYFV_Diff=1.41 [0.22-2.60]).

Conclusions: LOCI is an effective approach for training organizational leaders to support implementation of evidence-based digital health technologies in healthcare settings. Studies examining how policy-level variables interact with leadership training are needed.

Introduction: Randomized controlled trials (RCTs) are the gold standard design to evaluate physical activity interventions. Community-based participatory research (CBPR) approaches are increasingly embedded within RCTs to improve the application and impact of such interventions, particularly when they involve equity-owed communities. Longstanding critiques of this methodological fusion highlight key philosophical and methodological tensions between the underlying principles of CBPR and RCTs which may impact researchers' capacity to meaningfully conduct an RCT with a CBPR approach. Such critiques primarily revolve around differences in philosophical orientation (i.e. postpositivist vs. interpretivist/critical paradigms) and their impact on methods, procedures, and knowledge generation and outputs. Despite these critiques, little has been written about the realities of implementing an RCT using CBPR approaches and contending with these tensions in real time.

Purpose: This study seeks to address this gap by describing our experiences designing and implementing a community-based dance program with, by, and for women living with HIV.

Methods: Using a confessional tales approach, we reflect on the tensions between RCTs and CBPR and present our experiences delivering a dance program and our process in adapting and responding to the challenges we encountered.

Results: Our reflections focus on three themes: (i) The importance of articulating values and axiological commitments; (ii) Navigating the complexities of building trust and emergent contextual factors; and (iii) Emphasizing capacity building to promote sustainability.

Background: Suicide rates among Veterans were over 70% higher than non-Veterans in 2022, and nearly 60% had not recently used the Veterans Health Administration (VHA). Veterans have unique experiences and healthcare needs. VHA provides military culturally competent suicide prevention care to Veterans. There is a lack of research demonstrating that community agencies are adequately prepared to provide military culturally competent care, when appropriate.

Purpose: The purpose of this analysis was to understand organizational readiness and gaps related to providing military culturally competent Veteran suicide prevention programming in community agencies.

Methods: Semistructured qualitative interviews were conducted with 24 Veteran-serving community agencies to assess each organization's interactions with and navigation of VHA and care coordination, suicide prevention policies, procedures, and quality improvement, staff training on suicide prevention and military cultural competency, Veteran status screening procedures, crisis line dissemination, and suicide prevention metric tracking.

Results: Organizations lack awareness of their role in Veteran suicide prevention, and lack of readiness to implement comprehensive and military culturally competent Veteran suicide prevention programming. Salient implementation needs included: screening for Veteran status, collection of metrics, military cultural competency and suicide prevention training, Veterans Crisis Line dissemination, suicide prevention policies and standardized operating procedures, and care coordination between community agencies and VHA.

Conclusions: Findings suggest a need to bolster intraorganizational readiness to provide comprehensive and tailored suicide prevention programming to Veterans receiving care in the community with the aim of strengthening a community-wide safety net to reduce Veteran suicide deaths.

Background: Schools are ideal settings for implementing evidence-based physical activity interventions at scale due to their wide reach. However, dissemination strategies used to achieve scale are rarely reported.

Purpose: This study aimed to describe the strategy type, frequency, intensity, temporality, and pathways used in disseminating the TransformUs Secondary initiative across Australia over the first 16 months of national scale-up.

Methods: TransformUs Secondary is a whole-of-school initiative that targets behavioral, environmental, and pedagogical strategies inside and outside the classroom to reduce sedentary behavior and increase physical activity among adolescents aged 12-18 years. Since October 2023, the TransformUs team and 16 partner organizations collaboratively disseminated the initiative nationally. A dissemination activity log was used to record dissemination strategies, which were subsequently mapped post hoc to existing frameworks to categorize type, frequency, intensity, temporality, and pathways. Data are reported descriptively and graphically.

Results: Between October 2023 and February 2025, 10 discrete strategies were identified, with the most frequent and intensive strategies being "Promotion via mass media" (33.2%, 110 person-hours), "Develop educational materials" (20.8%, 48 person-hours), and "Maintain partner engagement" (12.4%, 20 person-hours). Strategy frequency and intensity fluctuated and increased after the initiative launch, shifting the focus from targeting partner organizations to targeting school staff. Notably, 54.3% of dissemination strategies occurred via direct pathways to school staff.

Conclusion: Reporting dissemination strategies and pathways clarifies how school-based interventions are scaled in practice, providing evidence to inform research, guide policy, and support effective implementation in schools.

Clinical trial information: The Clinical Trials Registration #ACTRN12622000600741.

Background: University is a period of increased vulnerability to mental health challenges, with anxiety and difficulties in emotion regulation among the most prevalent. Culturally adapted Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) group interventions can support student well-being, yet scalable options remain limited. To address this gap, group CBT for anxiety management and group DBT for emotion regulation were culturally adapted for university students in Türkiye. Adaptations involved revising content and language, removing culturally mismatched elements, and incorporating culturally relevant and age-appropriate material.

Purpose: This project aims to assess the feasibility and effectiveness of delivering culturally adapted group CBT for anxiety management and group DBT for emotion regulation.

Methods: The project includes three steps: (i) a comprehensive systematic review of group CBT and DBT interventions worldwide; (ii) translation, adaptation, localization, and development of 8-session group interventions; and (iii) implementation, data collection, and analysis. Participants are allocated to either the CBT group for anxiety management or the DBT group for emotion regulation.

Results: Standardized measures of anxiety or emotion regulation are administered at baseline, post-intervention, and six-week follow-up for both experimental and waitlist arms. Qualitative data are collected through semi-structured interviews conducted after intervention completion.

Conclusions: In this project, the feasibility and effectiveness of culturally adapted CBT and DBT group interventions for university students in Türkiye will be evaluated. Findings will inform wider-scale application of evidence-based therapies in university counseling centres in Global South and guide the design of a future randomized controlled trial.

Clinical trials information: NCT07096154 and NCT07096141 on clinicaltrials.gov.

Background: Translating public health research into practice remains challenging despite ongoing focus on evidence-based approaches. This study profiles the scope of research undertaken by the Prevention Research Collaboration (PRC), a university based applied public health research organization, with funding from both traditional academic sources and from policy agencies, and examines how it contributed to a translational, evidence-building approach in chronic disease prevention.

Methods: We analyzed PRC's research output using two complementary approaches: (i) a review of journal articles published from 2018 to 2024 where PRC researchers were lead or senior authors; and (ii) an examination of annual reports and workplans from 2013 to 2023 to identify major research programs. Research was classified according to public health evidence-building typology and whether it was investigator-initiated or policy-initiated.

Results: Overall, investigator-initiated research was dominant amongst journal publications, and particularly showcased problem definition studies. Intervention evaluation, as identified in journal publications and internal documents, was more likely to be policy-initiated. PRC demonstrated a high degree of collaboration with policy and practice professionals (42.5% of investigator-initiated and 50% of policy-initiated publications included policy co-authors). Key research areas across chronic disease prevention included physical activity (40.4% of publications), obesity prevention (14.2%), and tobacco control (12.8%).

Conclusion: This case study demonstrates that a small public health research group can successfully navigate the research-policy interface over a sustained period. PRC's continuity of management, staffing and funding arrangements, plus shared agenda and strong partnership with government, are considered to be key enabling factors for this collaborative evidence-building public health approach.

The National Institutes of Health (NIH) supports critical biomedical and behavioral health research conducted in the United States through grant funding every year. Recently, several NIH grants that had been awarded and passed full scientific peer review were suspended or canceled with little scientific or performance rationale. As a result of the NIH grant suspensions, important research related to Cancer, COVID-19, and mental health, among others, have been affected, with a loss of at least $643 million in funding. The grant suspensions have halted clinical trials in progress, and could be setting back important biomedical trials and research related to chronic disease, including cardiovascular disease and diabetes, which could benefit the public. While the grant cuts have been claimed to be due to a lack of scientific validity, rigor, or public benefit, these assertions are contrary to the findings of the NIH, researchers, and experts in the field who were initially involved in evaluating and awarding the grants. In order to prevent further unwarranted grant cancellations, we ask congress to consider holding oversight hearings regarding the NIH grant suspensions. Additionally, we ask that they introduce or support legislation that would help to prevent further unjustified grant suspensions and secure predictable funding for biomedical and behavioral health research. Congress must prevent the termination of NIH research grants that have already been awarded through lawful, competitive processes. Legislators must use their constitutional spending authority to ensure agencies execute appropriated funds, to ensure funding efficiency, life-saving medical innovation, and US scientific competitiveness globally. Lay summary Grants awarded by the National Institutes of Health (NIH) for health research, including research on vaccines and health disparities, have been suspended after going through the process of peer review and being awarded a grant. The reasons for the grant suspensions go against the findings of the NIH on the scientific validity, importance, and benefit to the public of the research being conducted, with a lack of justification being given to congress, the researchers, or the public. To address the NIH grant cancellations and try to prevent further suspensions, we ask congress to initiate hearings focused on the grant cancellations and introduce legislation to prevent unwarranted grant cancellations in the future.

Background: The increase in food insecurity (FI) during the COVID-19 pandemic resulted in greater demand for food- and nutrition-related services. Yet, little is known about the experiences of local food- and nutrition-related agencies and how they responded to address the increased need.

Purpose: We aimed to elucidate the perspectives and experiences of key informants from diverse food- and nutrition-related stakeholder agencies in addressing FI in San Diego County, CA during the COVID-19 pandemic.

Methods: The Socioecological Model and a capacity-oriented approach informed this qualitative study. Trained researchers conducted semi-structured interviews virtually on Zoom with 20 key informants from 14 food- and nutrition-related stakeholder agencies and analyzed data using thematic content analysis.

Results: Three linked themes emerged relating to how agencies addressed FI during the COVID-19 pandemic: (i) the pandemic uniquely influenced the agencies and the services they provided by presenting both challenges (e.g. limited in-person contact created distinct barriers) and opportunities (e.g. charitable contributions and federal funding increased); (ii) agencies leveraged new and existing within-agency capacities (e.g. adaptability, volunteers) and across-agency partnerships to address the increased demand; and (iii) agencies became forward-thinking as a result of the pandemic (e.g. focused on intentional and innovative strategic goals).

Conclusions: The COVID-19 pandemic influenced how food- and nutrition-related stakeholder agencies provided services, leading agencies to create new and leverage existing within-agency capacities and across-agency partnerships and to prioritize forward-thinking goals. Future research should consider the long-term implications of the pandemic on the effectiveness of agency services.

Sleep is a major health issue for young adults. While sleep hygiene interventions have small-to-moderate effects, better outcomes might be achieved by delivering interventions individually to those reporting sleep difficulties, or in the presence of a supportive other or companion. To examine the feasibility, acceptability, and initial effects of an adapted sleep hygiene intervention for young adults with poor sleep, we conducted an ORBIT Phase IIb pilot randomized controlled trial (n = 51). Young adults with poor sleep were randomized to receive a sleep hygiene intervention individually or with a companion. Sleep patterns were measured at baseline and 4 weeks. Participants completed daily dairies and wore wearable devices for the month following the intervention. Attrition at follow-up was minimal (3.9%), and missing rates were low for diary data (8%), and in line with prior studies for wearable devices (14%). Participants expressed high levels of satisfaction with the study, with no differences between study arms. Significant effects were found postintervention for all participants, indicating improved sleep quality (t = 6.14, P < .001), greater sleep duration (t = 3.8, P < .001), and reduced daytime sleepiness (t = 2.13, P = .039). There were no significant differences in sleep efficiency pre and postintervention, or between study arms for any sleep outcome based on self-reported and objective data. Results from this pilot provide evidence for the feasibility and acceptability of a sleep hygiene intervention for young adults and lay the groundwork for a larger, fully powered study.

Background: Despite the proven relationship between lifestyle and morbidity and mortality, rates of chronic disease (e.g. obesity) continue to rise in paradox to the myriad of studies supporting lifestyle behaviour change. Men have been less likely to seek out preventative care or lifestyle programs, putting them at risk. In response, Hockey Fans In Training (Hockey FIT) was developed as a group-based, lifestyle intervention leveraging the draw of hockey fandom to engage middle-aged men with overweight or obesity in lifestyle change. Encouraging pilot study results informed the optimization and delivery of the intervention through a cluster randomized controlled trial in 42 sites in Canada and the USA.

Methods: A process evaluation was conducted to evaluate intervention acceptability and fidelity and adaptations. Community-based sites were randomly allocated to Hockey FIT intervention (immediate program start) or wait-list control (12-month delay). Qualitative process evaluation data were collected from intervention sites and included seven virtual participant focus groups and one interview (n = 35 participants), open-ended participant feedback questionnaires (n = 316), interviews with program coaches (n = 22), post-session coach reflections (n = 233), and interviews with implementation partners (n = 16). A process of content analysis by question was performed and data saturation was reached.

Results: Themes fell into the following categories: (i) motivations for joining Hockey FIT; (ii) effective program components; and (iii) adaptations and suggested improvements.

Conclusions: The process evaluation detailed success engaging men in lifestyle change using sport fandom, and the importance of capitalizing further on competition within groups to drive behavioural change through user-friendly supports and greater engagement with hockey.

Clinical trial information: ClinicalTrials.gov. ID: NCT03636282.