Translational Behavioral Medicine最新文献

Background: Vida Sana is an evidence-based, culturally adapted weight management program based on Social Cognitive Theory for Latino adults classified as overweight with metabolic syndrome or prediabetes. Few studies have evaluated the implementation potential of these types of interventions conducted in clinical settings that seek to support weight management and reduce metabolic risk among Latino adults.

Purpose: To use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to understand implementation barriers and facilitators among multiple groups (patients, physicians, health coaches, recruiters) to guide future intervention refinement and delivery.

Methods: A longitudinal qualitative implementation evaluation was conducted to contextualize the results of the Vida Sana Hybrid Type 1 trial. Semistructured interviews were conducted with a subsample of 15% (n = 28) randomly selected main trial participants (patients) at baseline, 12 months (end of intervention), and 24 months (end of follow-up). Two health coaches and two physician champions were also interviewed. Four recruiters completed brief feedback forms. A framework analysis was conducted to analyze themes (RE-AIM domains) and deductive codes and to develop subthemes for each RE-AIM domain across time and group type.

Results: Analyses identified important implementation barriers and facilitators across RE-AIM domains potentially linked to Vida Sana's success. Patients indicated the intervention facilitated knowledge, skills, and self-monitoring for managing diet, physical activity, and weight. Barriers that may need to be addressed to increase effectiveness and sustainability include better health system supports. Although cultural adaptation was mentioned as supporting effectiveness, additional adaptations may be needed to maintain behavioral changes.

Conclusions: Vida Sana is implementable in primary care settings. Patients, clinicians, and study staff identified factors across RE-AIM dimensions that could increase the public health impact of the intervention by addressing barriers and building on facilitators.

Early childhood education (ECE) settings are important for the development of children's healthy eating and physical activity behaviors. Efforts to disseminate and implement health behavior promotion strategies in ECE settings have seldom optimized digital health, a missed opportunity highlighted by the COVID-19 pandemic. In this commentary, we discuss previous efforts to shift ECE-based health behavior programs to digital health modalities, notable opportunities for digital health in these settings, and a multilevel perspective to support future efforts. We propose future directions in digital health literacy, reaching various ECE settings, implementation science, and community partnerships to expand the use of digital interventions.

Background: The Push-Pull-Infrastructure (PPI) model is proposed as a strategy for disseminating health innovations. Using a PPI model, we developed and examined the feasibility of a community-based intervention to disseminate oral human immunodeficiency virus (HIV) self-testing (OHST) to men who have sex with men in Portland, OR.

Methods: We disseminated OHST kits through a network of commercial businesses (n = 6) serving the Lesbian, Gay, Bisexual, Transgender, and Queer plus community. Data were collected weekly on the number of kits distributed. Street intercepts were conducted with customers to assess the impact of promotional efforts on intervention awareness. Using a quasi-experimental design, we examined variation in the intensity of the promotional component on OHST dissemination.

Results: Over a 24-week period, we disseminated 2698 OHSTs. Dissemination rates were found to vary significantly with the intensity of the promotional campaign in a dose-response manner (e.g. high intensity = more dissemination). Customer awareness of the campaign increased significantly in the first 9 weeks (from 22% to 60%, P < .001). Within the geographic area studied, we found our dissemination rate to be comparable to or in excess of rates obtained by other county-level HIV-testing programs (i.e. 2698 OHSTs vs. 2561 in-person clinic-based tests; vs. 78 OHSTs disseminated online).

Conclusions: A PPI model based on a community commercial network approach was highly successful. The promotional component successfully increased customers' awareness of the intervention. Formative work, using a single-case changing-intensity design, provided evidence that warrants more extensive research on strategies for mounting a promotional component that builds on the principle of "more for less."

Background: After spontaneous coronary artery dissection (SCAD), 80% of survivor's experience fear of recurrence (FOR) which contributes to poorer clinical outcomes. Although FOR interventions (i.e. mindfulness-based cognitive therapy; MBCT) exist, none have been targeted to SCAD survivors.

Purpose: To assess the feasibility, acceptability, and preliminary FOR effects of MBCT for SCAD survivors (UpBeat-MBCT).

Methods: In this single-arm feasibility study, SCAD survivors were recruited from a hospital clinic to participate in UpBeat-MBCT, an 8-week group intervention combining cognitive-behavioral therapy, mindfulness meditation, and health behavior promotion. Participants completed surveys of psychological and behavioral variables pre-post intervention, actigraphy, and daily diaries of sleep and physical activity for 7 days pre-post intervention. The primary outcomes were feasibility and acceptability. Exploratory outcomes included changes in psychological and behavioral variables.

Results: SCAD survivors (N = 19) were enrolled across two sequential group cohorts (94% female, 95% non-Hispanic White, Mage = 51). In Cohort 1, results indicated that hearing about SCAD from others was emotionally activating and associated with high attrition (33% retained). Refinements for Cohort 2 included placing boundaries around group discussion, and 90% of participants were retained. Among retained participants across both cohorts (n = 12), program satisfaction was M = 8.3/10 (SD = 1.8), 91% (10/11) would recommend the program, and changes in FOR showed a medium-large effect size for improvement (d = 0.72).

Conclusion: UpBeat-MBCT is the first FOR intervention for SCAD survivors. When boundaries are set to guide discussion of SCAD, results support the feasibility, acceptability, and benefits of an MBCT group approach and the need for expanded testing.

Clinical trial information: The Clinical Trials Registration #: NCT04983680.

Background: Opioid overdose education and naloxone distribution (OEND) programs provide naloxone kits and training on recognizing and responding to opioid overdoses. While there are some early adopters of college campus OEND programs, this important setting remains underutilized.

Purpose: We conducted research on student-level perceptions of the reach, relevance, and fit of routine OEND implementation on a college campus in New York City.

Methods: Semi-structured, in-depth qualitative interviews (n = 40) were completed across three student groups: (i) those who were invited to and attended an OEND training, and opted to take a free naloxone kit (n = 24); (ii) those who were invited, but did not attend a training (n = 13); and (iii) those who were invited and attended a training, but did not take a kit (n = 3). We employed a framework-driven pragmatic qualitative approach using the Consolidated Framework for Implementation Research (CFIR).

Results: Our findings, synthesized across groups, were: (i) students were generally receptive to OEND program implementation on campuses broadly including their own, but perceived it as more relevant to the outer setting surrounding campus, which universities need to engage; (ii) beyond OEND programs, students expressed wanting better access to broader substance use and mental health services; and (iii) students described the need for improved university communications about its commitments to OEND program implementation to promote relevance and reach.

Conclusions: This study provides in-depth understanding of student-level perceptions around implementing campus OEND programs and identifies opportunities to improve future implementation and sustainability.

Background: Latines (Latina/o/x) in the United States are disproportionately impacted by type 2 diabetes. Yet, the National Diabetes Prevention Program (National DPP), an evidence-based lifestyle intervention created by the Centers for Disease Control and Prevention, has not successfully reached and engaged Latine individuals. Implementation science frameworks stand to enhance the study of these disparate outcomes to promote equitable delivery of the National DPP.

Purpose: This project leverages the Consolidated Framework for Implementation Research (CFIR) to assess how Lifestyle Coaches of the National DPP deliver this intervention to Latines across the U.S. to understand disparate outcomes better.

Methods: A total of 28 Lifestyle Coaches completed a semi-structured interview based on the CFIR, which assessed potential barriers and facilitators that might impact the program's implementation to this specific population. A qualitative content analysis was conducted to identify patterns across coaches, including coding agreement through consensual validation and triangulation with an implementation science expert.

Results: Primarily related to the Inner Setting and Characteristics of Individuals domains of the CFIR, Lifestyle Coaches demonstrated a strong need for cultural humility training to improve their awareness of barriers; Lifestyle Coaches felt unprepared to deliver the National DPP to Latine participants. Additionally, coaches expressed contradicting beliefs regarding the National DPP's need for cultural adaptation, suggesting a need for reframing the DPP's original findings in the context of more recent effectiveness research.

Conclusions: Understanding Lifestyle Coach's experiences with and beliefs in delivering the National DPP to Latine participants improves our understanding of the disparities in implementing the National DPP.

Background: Most breast cancer survivors (BCS) are insufficiently active. mHealth moderate-to-vigorous physical activity (MVPA) interventions for BCS are highly scalable, but the feasibility and acceptability of specific intervention components are unknown.

Purpose: The purpose of this study is to examine the feasibility and acceptability of the Fit2Thrive MVPA promotion intervention components.

Methods: Using Multiphase Optimization Strategy methodology, inactive BCS [n = 269; Mage = 52.5; (SD ± 9.9)] received a core intervention (Fitbit + Fit2Thrive smartphone app) and were randomly assigned to receive zero to five components for 12 weeks: (i) support calls; (ii) deluxe app; (iii) text messages, (iv) online gym; and (v) Buddy. Feasibility was measured through study accrual, retention, and adherence rates. Acceptability was measured via post-program evaluations.

Results: Enrollment rates were high; 419 BCS expressed interest in the study, 348 (83%) passed screening, and 269 (77%) were randomized; 98% (n = 264) received the intervention. Retention was 94% at 12 weeks. Fitbits were worn on 93% of study days. Most reported using the app ≥5 days/week (67%), enjoyed using the Fitbit (79%), and were satisfied with their study experience (88%) and the Fit2Thrive app design (79%). Component adherence rates and acceptability varied by intervention component. Component-specific effects on MVPA goal adherence and overall acceptability ratings were significant for telephone support calls.

Conclusions: Findings indicate Fit2Thrive's feasibility and acceptability were high overall but may vary by component. Future work should refine and test components to maximize participant engagement, efficacy, and scalability.

Clinical trial information: The Clinical Trials Registration NCT03131440.

Background: Rising use of electronic nicotine delivery systems (ENDS) and tobacco products among rural youth challenges tobacco control efforts, with higher use rates compared to urban youth. Exposure to tobacco retail outlets (TROs) and marketing influences tobacco use, but the longitudinal pathways of these factors in rural youth are underexplored.

Purpose: This study examines the feasibility of app-based ecological momentary assessment (EMA) in capturing real-time exposure to TROs and tobacco marketing and its link to tobacco use and susceptibility among rural youth.

Methods: Participants (n = 25) residing in Southwest Virginia were recruited for a 14-day EMA sub-study via the Effortless Assessment Research System (EARS) app. We assessed exposure to TROs and tobacco marketing as predictors and tobacco use susceptibility and past 24-hour tobacco use as outcomes. GPS data identified exposure to TROs within 100 m, and associations with tobacco outcomes were examined using generalized linear mixed-effect regression models.

Results: Most participants were 9th graders (36%; range 9th grade-12th grade) and white (56%), with slightly more female (56%) than male (44%). One-third were tobacco-susceptible, and 13% had used tobacco. TRO exposure was higher in activity space outside of the home and school (M = 7.2 exposures) than near home (4.1) or school (2.1). Over 14 days, 328 EMA responses were collected from 25 participants (72.9% response rate), demonstrating EMA's feasibility. TRO exposure was positively associated with recent tobacco use (P = .04) and negatively associated with recalling combustible tobacco ads (P = .03).

Conclusions: This study examined the feasibility of app-based EMAs to track rural youth's exposure to TROs, tobacco marketing, and tobacco outcomes. Findings demonstrate the feasibility of EMA for capturing tobacco-related exposures among adolescents.

Physical activity and nutrition programs improve children's health. However, cost and competition for resources between programs are common implementation challenges. Currently, no guidance exists for practitioners about how to spend money within various programs. This study examines spending patterns of schools that concurrently delivered multiple programs to help provide spending guidance. Middle schools (n = 8; 75% rural) that participated in the Healthy School Recognized Campus (HSRC) initiative were provided $3500. To achieve HSRC recognition, schools complete a school-wide walking program, a physical activity or nutrition program for students, and a physical activity or nutrition program for adults (teachers and parents). We tracked purchases, grouped receipts by categories and program, and analyzed spending using descriptive statistics. On average, schools spent $3383.26 ± $159.27. For both adult and teacher incentives, over half of the schools spent $0. Program equipment ($1145.14 ± $1139.10; e.g. cooking equipment and hydroponics kit) was the largest category of spending, followed by student incentives ($945.04 ± $946.62). Schools purchased 5031 items (628.88 ± 926.50 items/school) categorized as small student incentives (e.g. water bottles and gift cards), averaging $1.04 each, and 12 items (1.5 ± 2.78 items/school) on large student incentives (e.g. bike) averaging $124.72 each. On average schools completed 2.88 ± 0.83 (range 2-4) youth programs and 1.50 ± 0.93 (range 0-2) adult programs, which cost around $300-$1500 and $0-$700 per program, respectively. Schools spent almost all the money allocated for HSRC and made strategic spending decisions to maximize student engagement, specifically prioritizing student programs over adult ones. This information about how schools spend their money offers insights for decision-making in future programs.

Background: Screening for lung cancer via low-dose computed tomography of the chest can promote early detection and reduce mortality. However, since the United States Preventive Service Task Force (USPSTF) issued lung cancer screening guidelines in 2013, uptake has been low. The USPSTF revised the guidelines in 2021 to expand eligibility.

Purpose: To determine whether patient-clinician discussions about lung cancer screening differs from 2017 to 2022 following 2021 revisions to the guidelines for lung cancer screening.

Methods: Data were obtained from the Health Information National Trends Survey (2017, 2020, and 2022). Community-dwelling US adults (N = 2973) were in the eligible age range for lung cancer screening (55-80 for 2017 and 2020; 50-80 for 2022), reported current or former smoking, and had no prior history of lung cancer. The primary outcome was self-reported patient-clinician discussions about lung cancer screening within the last 12 months.

Results: The weighted proportion of respondents who discussed lung cancer screening with a healthcare provider was 12.34% in 2017, 13.77% in 2020, and 9.42% in 2022. The odds of reporting screening discussions were significantly lower in 2022 than 2020 (OR = 0.58, 95% CI [0.36, 0.93]). Individuals with insurance (OR = 9.12, 95% CI [2.81, 29.96]) and those who were currently smoking (OR = 2.80, 95% CI [1.89, 4.13]) had higher odds of discussing screening.

Conclusions: Patient-clinician discussions about lung cancer screening were lower in 2022 than 2020, despite revised guidelines that broadened eligibility. Research should explore strategies to increase awareness of lung cancer screening and prioritize discussions about screening among those who are uninsured and formerly smoked.