Translational Behavioral Medicine最新文献

Background: Access to comprehensive lactation support services is essential for promoting successful breastfeeding practices, which have significant health benefits for both mothers and infants. Despite these benefits, disparities in lactation support persist, particularly among low-income populations reliant on Medicaid. Currently, many state Medicaid programs do not reimburse outpatient visits with International Board-Certified Lactation Consultants (IBCLCs) or other healthcare providers for breastfeeding support. This lack of coverage creates a critical gap in access for marginalized and low-income communities, which often intersect with communities of color.

Objective: To understand the current landscape of state-level Medicaid policies on outpatient lactation consultation and other breastfeeding services, and to provide recommendations for expanding coverage in states without such provisions.

Methods: A comprehensive search of Medicaid state plan amendments (SPAs) was conducted to identify state-level policies on Medicaid coverage for outpatient lactation consultants and other breastfeeding services. This search resulted in a total of nineteen SPAs from January 2012 to December 2024, which were included for further analysis.

Results: Fourteen states have amended their state Medicaid plans to include provisions for lactation coverage and/or reimbursement (CO, CT, DE, GA, IL, NE, NH, NJ, NM, NY, OH, OR, TN, and VT), with 19 approved amendment proposals, some of which apply to the same states (NH, NY, and OH). Eight SPAs explicitly recognize IBCLCs as billable provider types (CO, DE, IL, NH, NJ, OR, TN, and VT), while seven SPAs extend this designation to other lactation support providers (CO, DE, GA, IL, NH, NM, and TN). Five states have session limits for lactation support (DE, GA, NE, NJ, and OR), and two states restrict coverage to sessions conducted during the postpartum period, with exceptions allowed for medical necessity (NE and OR). Additionally, three states (CO, CT, and NH) provide reimbursement for hospital-grade breast pumps or other breastfeeding-related supplies.

Conclusion: Policy recommendations include: (i) Implementing separate reimbursement through Medicaid for IBCLC services, (ii) securing state funding to meet federal matching requirements, and (iii) developing and submitting a SPA through state Medicaid programs.

This review assessed the effect of strategies designed to sustain the delivery of evidenced based interventions (EBIs) which target behavioural risk factors linked to leading causes of chronic disease in clinical and community settings. Seven electronic databases were searched for randomised controlled studies published from earliest record to November 2022. Studies were included if they tested a strategy to sustain the delivery of an EBI within clinical or community settings. Results were synthesised using vote counting based on direction of effect, and reported in accordance with non-meta-analytic review standards following the Synthesis Without Meta-analysis (SWiM) guidelines. Three studies met the study inclusion criteria. Two studies were community-based, with one conducted in Australian community sports clubs and the second in afterschool clubs in the United States. The single clinical-based study was conducted in community health care centres in the United States. Across the three studies, 25 strategies were employed and only two strategies were common across all studies. Synthesis using vote counting based on direction of effect indicated that two of three studies favoured the intervention as positively impacting sustainment of EBIs. Few studies have been conducted to assess the effect of strategies designed to support sustainment of EBIs for chronic disease prevention in clinical and community settings. As such, it is difficult to determine the effect of strategies designed to support sustainment. Further research with comprehensive reporting of the selection, use and testing of sustainment strategies is needed to advance understanding of how to sustain EBIs in clinical and community settings.

Traditional approaches to increase vaccination rely upon educating patients about vaccines. However, research shows that "knowing" vaccines are important is often insufficient: patients need to believe that getting vaccinated is important. Evidence-based motivational approaches, such as motivational interviewing/communication (MI/MC), have become increasingly popular for promoting good health behaviors, including vaccination. The objective of this review was to compare the efficacy of educational and MI/MC interventions on vaccination rates relative to each other and to usual/standard care. Pubmed, PsycINFO, and Cochrane trials databases were searched to identify articles that assessed vaccination rates post-patient education or MI/MC vaccine counseling in the context of adult or child vaccination (PROSPERO: CRD42019140255). Following the screening, 118 studies were included (108 educational and 10 MI/MC). The pooled effect sizes for vaccination rates corresponded to 52% for educational interventions (95% CI: 0.48-0.56) and 45% for MI/MC interventions (95% CI: 0.29-0.62) (P = .417). Fifty-nine randomized controlled studies (55 educational and 4 MI/MC) showed that, compared with usual/standard of care, exposure to education and MI/MC was associated with a 10% (RR =1.10; 95% CI =1.03-1.16, P = .002) and 7% (RR =1.07; 95% CI =0.78-1.45, P = .691) increased likelihood of getting vaccinated, respectively. Results suggest comparable efficacy of educational and MI/MC interventions on vaccination uptake and a small superiority of educational interventions compared with usual/standard of care. The overall poor quality of the studies, including lack of fidelity assessments of MI/MC studies, contributes to low confidence in the results and highlights the need for better quality intervention trials examining the efficacy of MI/MC for vaccine uptake.

Background: Perinatal anxiety is prevalent, particularly among historically marginalized groups who face barriers to accessing interventions like cognitive behavioral therapy (CBT). While digital CBT adaptations for this population show promise, research on implementation remains limited.

Purpose: This study engaged potential implementers-perinatal clinicians, doulas, and psychiatrists-to explore perceived barriers and facilitators of digital CBT (BigHealth's Daylight app) use among racially marginalized and low-income perinatal people.

Methods: As part of the HOPE THRIVE study (transforming health and reducing perinatal anxiety through virtual engagement), we conducted two focus groups (n = 11) with California-based clinicians and service providers working with low-income (Medicaid-eligible) perinatal patients. The reach, effectiveness, adoption, implementation, and maintenance implementation framework guided our focus group questions and deductive analysis.

Results: We identified 12 perceived barriers and facilitators (themes) that participants believed would influence the reach, effectiveness, adoption, implementation, and sustainability of digital CBT in this population. These themes included intervention design elements, differences between potential users and nonusers, and broader provider- and system-level factors.

Conclusion: While clinicians and service providers viewed digital CBT-specifically Daylight-as acceptable and beneficial for increasing access among marginalized perinatal populations, critical implementation considerations emerged during the focus groups. Addressing these factors through tailored strategies and culturally relevant adaptations is essential for successful implementation, particularly when scaled to healthcare settings. Future research should further explore these issues to support equitable, sustainable digital CBT delivery.

Objective: Veggie Van (VV) is an evidenced-based intervention for improving diet through a mobile market (MM) and is disseminated through an online toolkit. Understanding the user experience of the VV toolkit is crucial to inform its refinement and ensure future implementation success and positive public health impact.

Design: We conducted semi-structured interviews to understand the VV toolkit user experience including their familiarity and utilization of the toolkit, experience navigating, feedback on specific content, comprehension of the evidence base, and feedback on training and technical assistance options. Interviews were deductively analyzed using Atlas.ti 22.0 qualitative software.

Setting: Interviews were conducted via web conference over the spring and summer of 2022.

Participants: Interviews were conducted with 16 key informants (KIs) from established MM organizations and frequent toolkit users.

Results: The majority of KIs were previously familiar with the VV toolkit and had used it in their work or referred others to the toolkit. The toolkit was perceived to be thorough and well-done, but more appropriate for an organization earlier in the process of starting an MM, despite the toolkit being intended for organizations of all experience levels. KIs cited that the toolkit facilitated planning for markets and bolstered their legitimacy in conversations with stakeholders. Most could not accurately define the core components of the VV model and how it differed from other models; it was also unclear to what degree practitioners are implementing its practices.

Conclusions: This evaluation provided valuable feedback on the perceptions and utility of our online toolkit as well as comprehension of the evidence base. Clarifying the VV model components and enhancing the appeal of the toolkit to more established practitioners will ensure proper knowledge translation and increase the reach of the intervention.

Background: ReOpening Schools Safely and Educating Youth (ROSSEY) was a cluster randomized controlled trial of a risk communication intervention for COVID-19 prevention to promote safe return to school among students in a rural, agricultural community.

Purpose: This qualitative study evaluated the implementation of a risk communication intervention and a school district's COVID-19 testing program through parent focus groups and interviews with school staff and students.

Methods: Parents (n = 37), students (n = 19), and school staff (n = 14) from seven schools that received the intervention shared their experience via focus groups and interviews informed by the RE-AIM framework. Deductive and inductive coding was conducted by four data analysts. Themes were validated with community members.

Results: Parent focus groups, student and staff interviews provided insight into the ROSSEY study implementation. We identified five main themes: (i) social and financial drivers of participation; (ii) personal beliefs and unique challenges to research participation; (iii) intervention reinforced knowledge and shifted behavior; (iv) the appeal of comic books and videos supported adoption; and (v) multimodal communication and partnerships enhanced implementation.

Conclusions: The risk communication intervention was deemed culturally appropriate, reinforced previous knowledge, and encouraged adoption of preventive behaviors. The partnership with the school district and collaboration with the district's COVID-19 testing program ensured success of recruitment, study implementation, and adoption of preventive behaviors.

A range of health behavior interventions demonstrate efficacy in controlled settings, but face challenges when it comes to real-world implementation. These challenges arise due to the variation in participant, implementation staff, and implementation organization needs and resources which influence intervention delivery and effectiveness outcomes of these evidence-based interventions. We present potential approaches and considerations to prevent common pitfalls throughout the process of evidence-based intervention adoption, implementation, and sustainment. This includes using program theory, active engagement, cultural considerations, and understanding the connection between strategies, mechanisms, and outcomes right from the beginning to diligently develop, evaluate, implement, and disseminate evidence-based interventions. These approaches will help behavioral medicine/health psychology implementation researchers to get one step closer to the holy grail: To integrate evidence-based interventions sustainably into programs, systems, policy, and environments to facilitate long-term health behavior change and better health.

Background: In recent years, the concept of adaptive interventions (AIs) has attracted the attention of researchers in the medical field. Our study aimed to visualize the publications to determine the hotspots and frontiers in research on AIs and provide guidance and reference for further study.

Methods: We searched the Web of Science Core Collection up to December 2024, and only articles and review articles about AIs were included. The countries of origin, authors, co-citation references, hotspots, and frontier were analyzed by VOSviewer V.1.6.20, CiteSpace V.5.7.R5, and Scimago Graphica.

Results: A total of 429 publications were identified, including 399 original studies and 30 reviews. The number of studies has proliferated since 2016. The United States, especially the University of Michigan, made significant contributions to this field. There was a closer collaboration among author teams and more frequent AIs research development and collaboration in Europe, the United States, and Australia. Just-in-time adaptive interventions are the predominant intervention design of concern at this stage, with addictive behavior and mental health as the main fields of research in medicine. AIs utilizing mobile health, combining ecological momentary assessment tools, may represent an emerging trend in future research.

Conclusion: Researchers' understanding of AIs has improved dramatically over the past 20 years. At present, the emphasis of research on AIs is gradually transitioning from initial theoretical development to practical application and effectiveness evaluation, and we look forward to seeing it applied in more areas.

Background: Despite 40 years of evidence supporting psychosocial interventions as a component of comprehensive cancer care, patients continue to report vast unmet psychosocial needs and distress. Cognitive behavioral therapies for cancer distress (CBT-C) are the most rigorously tested class of psychosocial interventions for cancer care.

Purpose: To report clinical effectiveness outcomes of cancer-related distress and self-efficacy following implementation of best-evidence CBT-C, adapted for a real-world, billable practice setting.

Methods: Patients who completed group-delivered, CBT-C (10 intervention hours, 5 sessions) in the practice setting were invited to enroll in a research study to document cancer distress across the year following CBT-C. Participants (n = 65) were primarily middle-aged (mean 50.5 years, 17% were young adults ≤40 years), female, and White. Analyses utilized mixed linear models with intent-to-treat procedures. Given group delivery and social skills training content within CBT-C, social self-efficacy was assessed as a potential treatment mechanism.

Results: Distress decreased across the year following CBT-C (mean score change of 20 points for YAs, 6 points for non-YAs), with statistically significant age x time effects. Within-person improvements in social self-efficacy scores were related to reductions in cancer distress, including distress subscales of intrusive thoughts, avoidant coping, and hyperarousal. The model explained 76.6% of the total variance in cancer distress.

Conclusions: This study demonstrates the effective translation of CBT-C from controlled research trials to the practice setting. CBT-C effectiveness within a mixed-cancer population and relatively rural region of the US is also supported. CBT-C can be effectively translated to the practice settings for which it is intended.