Translational Behavioral Medicine最新文献

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.

Background: Indoor tanning (IT) causes skin cancers, including potentially deadly melanoma. IT often starts during youth, a critical time for deleterious skin damage. About half of the US states have enacted laws banning IT for minors under age 18.

Purpose: This study reports qualitative findings from interviews with key informants (KIs) involved in IT legislative efforts to identify/describe factors influencing law enactment, based on the multiple streams framework.

Methods: Guided by expert advisors and using snowball-sampling, KIs from 16 states with most recently enacted IT laws regulating minor access and states without restrictions were contacted. In virtual interviews, KIs shared their unique "story" of IT bill efforts, enactment, implementation, impact, and potential future directions, which were transcribed and qualitatively coded by trained staff.

Results: Although KI roles (e.g. legislators, advocates, clinicians, and melanoma survivors; n = 64) and legislative processes vary by state, similar facilitators and barriers to IT bill passage were identified: personal stories, advocacy, opposition, preparation, legislator education, economic/enforcement issues, bill stringency, political values/partisanship, and legislative process. Other factors influencing bill enaction included failed Food and Drug Administration attempts toward federally banning minor IT and competing priorities.

Conclusions: Despite evidence of laws' impact on minors' IT, policy enaction is challenging and slow. Understanding key facilitators and barriers may help advocates to advance legislation efforts. Advocating for stringent laws necessitates consideration of potential downstream effects. For example, even with policy enactment, KIs believed enforcement and compliance were likely insufficient and variable, with minors continuing to indoor tan, putting them at risk for potentially deadly skin cancer.

Background: Physical activity and locomotor skills influence children's current and future health trajectories.

Purpose: To (i) assess the effect of Sustainability via Active Garden Education (SAGE) intervention on locomotor skills in children, and (ii) test whether changes were related to the fidelity and dose of the program.

Methods: SAGE installed a garden in early care and education (ECE) facilities and implemented a curriculum consisting of 12 one-hour sessions to promote healthy eating and physical activity. Quantitative locomotor skills were assessed by the number of laps completed on the progressive aerobic cardiovascular endurance run (PACER), while qualitative assessment was conducted using the CHAMPS protocol. Fidelity was the number of active games completed, while dose was the number of gross motor skills implemented. Two-level linear mixed models adjusted by sex and age examined the effects of SAGE on locomotor outcomes. Fidelity and dose were tested as moderators.

Results: A total of 173 children [50.90% boys; mean age 4.43 years (SD: 0.38)] participated in the study. Significant improvements over time were observed on overall qualitative locomotor score [β = 2.51; 95% confidence interval (CI): 1.32; 3.70], and the subscores of slide (β = 1.04; 95% CI: 0.54; 1.55) and hop (β = 1.16; 95% CI: 0.61; 1.72). There was a significant effect of SAGE on the hop skill score in the intervention group compared to control (β = 1.14; 95% CI: 0.41; 2.24). Fidelity and dose delivered did not moderate changes.

Conclusions: Children's overall qualitative locomotor score, hop, and slide skills increased across both groups. Participation in SAGE improved the hop locomotor skill.

The clinical trials registration: The study clinical trials registration is NCT03261492.

Background: Asthma affects approximately 8.2% of United States school-aged children, with a significantly higher prevalence among socioeconomically disadvantaged minority children. Among Diné (Navajo) children living on the Navajo Nation, asthma rates exceed 20%. The community asthma program (CAP) was developed in partnership with the Navajo Nation following a year-long community engagement process. CAP is a 7-year, multicomponent, evidence-based intervention designed to improve asthma management within Indian Health Service facilities and Diné K-12 schools.

Purpose: This study evaluates CAP's implementation processes and outcomes using document analysis, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR) frameworks. We describe our data sources, coding methods, and their contributions to understanding implementation, as well as discuss strengths, limitations, and implications for process evaluation.

Methods: CAP research documents were collected from the 2017 community engagement period through the intervention's conclusion in 2023. When COVID-19 limited access to implementation settings, additional data sources, including email correspondence and meeting minutes, were analyzed using document analysis to examine activities, experiences, and attitudes related to CAP implementation.

Results: Multiple data sources, including RE-AIM forms, staff interviews, and research team documents, identified key process indicators and explanatory factors. While these sources provided valuable context, system- and provider-level fidelity indicators are needed to fully assess intervention reach and quality.

Conclusions: Findings underscore the importance of collecting process data throughout implementation and leveraging diverse data sources to capture the local implementation context comprehensively.

Clinical trial information: The Clinical Trials Registration # NCT03377647.

Adherence to adjuvant endocrine therapy in women with breast cancer is low. We conducted a 24-1 fractional factorial pilot optimization trial to test four intervention components supporting medication adherence [text messages, information leaflet, acceptance and commitment therapy (ACT), self-management website], in the preparation phase of the multiphase optimization strategy. Guided by the National Institute of Health Behavior Change Consortium fidelity framework, we investigated fidelity of design, training, delivery, receipt, and enactment of four intervention components. Women prescribed adjuvant endocrine therapy (n = 52) were randomized to one of eight experimental conditions comprised of combinations of the four intervention components (ISRCTN: 10487576). We assessed fidelity using self-report data (4 months post-randomization), trial data, ACT session observations, behavior change technique (BCT) coding, and interviews with participants (n = 20) and therapists (n = 6). Design: Each intervention component targeted unique behavior change techniques with some overlap. Training: All 10 therapists passed the competency assessment. Delivery: All leaflets (27/27) and website (26/26) details were sent, and ACT procedural fidelity was high (85.1%-94.3%). A median of 32.5/41 (range 11-41) text messages were delivered, but a system error prevented some messages being sent to 22 of 28 participants. Receipt: Most participants [63.0% (ACT, leaflet) to 71.4% (text messages)] read all or at least some of the intervention components they were randomized to receive. Enactment was reported most positively for ACT. All intervention components demonstrated adequate fidelity. We have provided an exemplar for assessing fidelity using the National Institute of Health Behavior Change Consortium framework in the preparation phase of multiphase optimization strategy.

Healthcare providers (HCPs) face high rates of distress, experienced as burnout, moral distress, compassion fatigue, and grief. HCPs are also experiencing a crisis in meaning whereby distress is associated with disconnection from meaning in work and, in turn, a lack of meaning in work can further perpetuate distress for HCPs. Although scalable systems-level solutions are needed to tackle multidimensional HCP distress, it is also necessary to address HCP suffering at individual, team, and institutional levels. Targeted interventions to alleviate HCP distress are limited. Meaning-centered psychotherapy (MCP), a brief, evidence-based, intervention first developed for persons with advanced cancer, holds promise to mitigate HCP distress. This study adapted MCP for HCPs through feedback from a multidisciplinary sample of clinicians trained in MCP and working in healthcare settings. A survey was distributed electronically between November and December 2023 to HCPs previously trained in MCP assessing quantitative and qualitative feedback on the appropriateness of MCP for HCPs, the relevance of MCP session topics and exercises, and implementation barriers and facilitators. Descriptive statistics on relevant participant ratings were calculated; a matrix analysis approach was used for qualitative data. Forty participants, primarily mental health providers, expressed that MCP principles were highly relevant for HCPs and offered key insights on appropriate intervention modifications, including the need for a primary focus on meaning in professional life, reduced intervention length, and delivery in group format. Feedback informed critical adjustments to promote appropriateness and acceptability of MCP-HCP which is poised for pilot testing to determine its feasibility and preliminary efficacy for HCPs.