Translational Behavioral Medicine最新文献

Background: The Veterans Affairs National TeleNeurology Program (NTNP) was developed to improve access to outpatient neurology care by leveraging telehealth to create efficient, cost-effective virtual video clinics. Studies suggest that NTNP led to shorter wait times, fewer community care neurology (CCN) consultations, reduced travel burden, and high patient/provider satisfaction.

Purpose: This evaluation aimed to identify combinations of facility-level conditions that uniquely distinguish VA Medical Centers (VAMCs) with higher and lower usage of NTNP consults for stroke patients.

Methods: We conducted a mixed-methods evaluation of a Veterans Affairs (VA) quality improvement program extending access to outpatient neurological care through telehealth to Veterans receiving care in facilities with highly rural populations. The sample included consults placed to NTNP or CCN for outpatient stroke diagnoses. We applied configurational comparative methods to identify explanatory factors related to implementation success. The analysis used categorical factors to distinguish facilities with higher usage of VA NTNP consults compared to CCN. The primary outcome was the ratio of NTNP consults (video plus e-consults) placed to all consults (NTNP plus CCN) for Veterans with stroke. The proportion of consults placed to NTNP ranged from 3.3% to 49.3%, with a gap between two categories: the eight highest (over 22.4%, "higher") and the four lowest (under 14.2%). Data sources included administrative records, facility characteristics, leadership engagement ratings, and interviews with NTNP leadership/TN providers.

Results: Among 12 VA facilities evaluated, those with high NTNP consult usage (≥22.4%) exhibited three specific facility configurations, each of which were sufficient for the outcome to occur: an absence of local VA neurology providers, higher number of NTNP clinic days (≥0.65 per week), or a lower annual volume of stroke patients. These findings indicate that targeted adjustments in staffing or clinic availability may effectively increase NTNP adoption, especially in facilities with limited access to local neurology resources.

Conclusions: This mixed-methods evaluation offers a strategic framework to enhance NTNP implementation by aligning facility resources with program goals based on stroke volume and local neurology resources. High-usage implementation of VA NTNP was observed to have simpler pathways to success compared to more complex reasons for lower usage.

Background: Stigma is a pervasive and distressing problem experienced frequently by lung cancer patients, and there is a lack of psychosocial interventions that target the reduction of lung cancer stigma. Mindful self-compassion (MSC) is an empirically supported intervention demonstrated to increase self-compassion and reduce feelings of shame and distress in non-cancer populations. However, there are several anticipated challenges for delivering MSC to lung cancer patients, and modifications may be needed to improve acceptability, appropriateness, and feasibility.

Purpose: To gather feedback from lung cancer patients, psycho-oncology researchers, expert MSC teachers, and oncology clinicians to identify themes supporting the adaptation of MSC to reduce lung cancer stigma.

Methods: We conducted a two-phase process of stakeholder focus groups with researchers and clinicians (n=12) and semi-structured interviews with lung cancer patients (n=14) with elevated stigma. Transcripts were analyzed using thematic content analysis.

Results: Five themes were identified: (i) Patients expressed a desire for an intervention that bolstered self-compassion and addressed stigma; (ii) Intervention instructions were acceptable and understood clearly; (iii) Patients preferred intervention content to directly address lung cancer and stigma yet mentioned that doing so should be done with sensitivity; (iv) Ambivalence about delivering the intervention in person or remotely; (v) Acceptance for an intervention of 8-weeks (or longer) with 90-minute sessions and a group size of ≤ 15.

Conclusions: Findings informed the development of an adapted clinical protocol for MSC for lung cancer (MSC-LC), which can be pilot tested to determine implementation outcomes (e.g. acceptability, feasibility, efficacy).

Evidence-based approaches to screening and treatment for unhealthy alcohol use have the potential to reduce morbidity and mortality but are currently underutilized in primary care settings. To support implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) by identifying goals co-developed by clinics and practice facilitators in a flexible implementation study. In a pragmatic implementation study, we used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. Our study used a tailored approach, in which facilitators and clinics co-identified implementation goals based on clinic needs. We used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. With support from practice facilitators, clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g. data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree summarizes emergent findings into a tool to support future implementation of SBIRT in primary care settings. A facilitator-supported, tailored approach to SBIRT implementation enabled clinics to identify a variety of goals to improve SBIRT and MAUD implementation. These identified priorities, along with a decision tree describing the hierarchical structure of these goals, could support future implementation efforts.

Barbershop-based efforts to promote health among Black men have been uniquely successful. Despite the success of these efforts, the emphasis on outcomes as opposed to how these outcomes can be achieved has created a gap in the literature. The present study addresses this gap by describing implementation-related program priorities that Black men identify for barbershop-based interventions. Twenty-three Black men participated in implementation premortem activities. Participants were: (i) given details about a barbershop-based health promotion effort, (ii) told that the effort had failed, and (iii) were asked to identify potential sources of program failure and strategies to overcome those challenges. The frequency of program priorities was calculated based on the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, and focus group data were analyzed using an inductive thematic qualitative data analytic approach. Data analyses occurred in three phases: (i) excerpts were grouped by Phase, Domain, and Construct of the EPIS Framework; (ii) themes within each excerpt were then identified using an inductive approach; and (iii) themes were organized into conceptually similar and parsimonious categories. Participants suggested that the biggest source of program failure was that more attention needed to be paid to Program Fit during the Implementation Phase. Participants reported concerns with the accessibility and convenience of the effort. Additional participant concerns included economic issues, community ownership, climate, staffing processes, cultural sensitivity, engagement, and trust. The implementation of health promotion programs for Black men should pay particular attention to how the intervention fits the needs, lives, and contexts of potential participants.

While digital cardiac rehabilitation (CR) is an effective alternative to center-based CR, its components and mechanisms of change remain poorly understood. The Multiphase Optimization Strategy (MOST) provides a framework that allows the effects of individual components of complex interventions to be studied. There is limited guidance within MOST on how to develop a conceptual model. This article describes the development of a conceptual model of digital CR. The conceptual model was developed based on several strands of evidence: (i) a systematic review of 25 randomized controlled trials to identify the behavior change techniques in digital CR interventions, (ii) a qualitative study of patients' (n = 11) perceptions of the mechanisms of digital CR, and (iii) a review of international guidelines. Tools and frameworks from behavioral science, including the Behaviour Change Wheel, Capability, Opportunity, Motivation and Behavior model, and Theoretical Domains Framework were used to integrate the findings. An initial conceptual model of digital CR was developed and then refined through discussion. The conceptual model outlines the causal process through which digital CR can enhance outcomes for patients with cardiovascular disease. The model illustrates the key intervention components (e.g. goal setting and self-monitoring, education, exercise training), targeted outcomes (e.g. physical activity, healthy eating, medication adherence), and theorized mediating variables (e.g. knowledge, beliefs about capability). The article provides an example of how behavioral science frameworks and tools can inform the preparation phase of MOST. The developed conceptual model of digital CR will inform guide decision-making in a future optimization trial.

Community-based physical activity programmes benefit persons with disabilities. However, there is a lack of evidence-based tools to support kinesiologists' training in such programmes. This study aimed to co-create and evaluate physical activity training modules for community-based adapted physical activity (APA) programmes. In Phase 1, a working group (n = 8) consisting of staff, kinesiologists from two community-based APA programmes, and researchers met over four online meetings to discuss needs, co-create training modules, and assess usability. In Phase 2, a pre-post quasi-experimental design evaluated changes in capability, opportunity, and motivation of kinesiologists (n = 14) after completing the training modules, which included standardized mock client assessments and participant ratings of module feasibility. Means and standard deviations were computed for feasibility, followed by paired-samples t-tests, along with Hedge's correction effect size. Mock client sessions underwent coding and reliability assessment. The working group meetings generated two main themes: training in (i) motivational interviewing and behaviour change techniques and (ii) optimizing APA prescription. Nine online training modules were created. In Phase 2, medium to large effects of training modules were observed in capability (Hedge's g = 0.67-1.19) for 8/9 modules, opportunity (Hedge's g = 0.77-1.38) for 9/9 modules, and motivation (Hedge's g = 0.58-1.03) for 6/9 modules. In mock client assessments, over 78% of participants appropriately used five behaviour change techniques and, on average, participants demonstrated good use of motivational interviewing strategies. The findings indicate that training kinesiologists was feasible and has the potential to enhance community-based physical activity programmes for persons with disabilities.

Background: Hearing loss and tinnitus are pervasive disabilities globally, which significantly impact individuals' quality of life. Integrating Digital Health Interventions (DHIs) with traditional audiological management has proven beneficial for hearing loss and tinnitus management. Although it is established that DHI engagement is important for the real-world effectiveness of DHIs, there is a lack of systematic evidence aiming to understand engagement with DHIs in audiology.

Purpose: This systematic review identified factors associated with hearing healthcare DHI engagement to inform future DHI development and research in audiology.

Methods: Adhering to Synthesis without Meta-Analysis guidelines, we conducted a mixed-methods systematic review using a convergent integrated approach. A comprehensive search across seven databases until December 16, 2023, identified 62 studies meeting inclusion criteria. Data extraction involved modifying the Joanna Briggs Institute (JBI) extraction form and deductive coding using the Perski et al. (2017) framework to identify factors related to engagement.

Results: The review revealed a diverse range of factors associated with DHI engagement in the audiology literature.

Conclusion: Analysis within the Perski et al. (2017) framework highlighted the importance of user-related constructs, such as enhancing DHI accessibility, empowering users, and aligning DHIs with user needs and lifestyles in facilitating engagement. Due to the limited number of studies focusing on engagement as the primary outcome, we based our inferences on secondary outcomes and discussions from the available literature. While this review consolidates existing knowledge on engagement, it underscored the imperative for more in-depth investigations into engagement with hearing healthcare DHIs.

Seasonal influenza remains a persistent public health threat in the United States, causing tens of thousands of deaths and hospitalizations each year despite the availability of effective vaccines. Ongoing challenges-including low vaccination uptake, health inequities, and declining trust in public health institutions-have hindered prevention efforts and left vulnerable populations at heightened risk. The Society of Behavioral Medicine calls for maintaining Medicaid funding, investing in vaccination promotion, and restoring public health data sources to mitigate the impact of influenza. During the 2024-25 flu season, the United States experienced its highest flu case numbers since 2009, with low vaccination uptake and deepening public mistrust in health institutions. Flu-related mortality remains substantial, disproportionately affecting older adults and Black Americans, while proposed federal funding cuts to Medicaid, Medicare, and biomedical research threaten the nation's epidemic response capacity. Sustained investment in Medicaid, vaccination promotion, and data-driven research is essential to protect vulnerable populations, reduce flu-related illness and death, and strengthen public health preparedness.

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.