International Journal of Behavioral Medicine最新文献

Background: Behavioral medicine has made key contributions toward improving health outcomes. Engaging community partners in research is critical to addressing persistent health inequities. The aim of this scoping review was to explore how researchers engaged community partners within the field of behavioral medicine research from 2005 to 2023.

Method: Publication databases and gray literature were searched for research that engaged community partners to address questions relevant to behavioral medicine. Articles were screened by title and abstract, and then by full text. Articles meeting the inclusion criteria were coded using the framework provided by the Engagement Navigator to identify engagement approaches, methods, and tools and when they were used during the research.

Results: Of 1486 articles initially identified, 58 met the inclusion criteria. Most articles used well-known approaches (e.g., community-based participatory research; 67%), methods (e.g., advisory committees; 59%), and tools (e.g., interviews; 41%), and engaged with healthcare service providers (62%) and/or patients (53%). Community partners were most often included in research planning and design (79%), and less often in dissemination (45%).

Conclusion: Community engagement has considerable potential to address health inequities. Our assessment of the approaches, methods, and tools used by behavioral medicine researchers to engage with a diverse range of community partners points toward promising strategies for enhancing the impact of community engagement. Researchers should incorporate explicit descriptions of community engagement strategies in publications, an outcome that could be facilitated by clear publishing guidelines, structured reporting tools, and clear messaging from funders about the value of community engagement in behavioral medicine research.

Background: Multiple systematic reviews have found that type 2 diabetes is associated with cognitive decrements. However, these reviews are heterogeneous in terms of methodology, quality and results, making it difficult for researchers and clinicians to build an informed overall picture. We therefore conducted a review of systematic reviews on the association between type 2 diabetes and cognitive decrements in relation to healthy controls.

Methods: Following a pre-registered research protocol, we searched four major databases. Nine systematic reviews met our inclusion criteria: seven were meta-analyses and two were narrative syntheses. We assessed the risk of bias in each review and reported all effect sizes and confidence intervals obtained.

Results: Type 2 diabetes was associated with cognitive decrements in all reviews, with small or negligible effect sizes obtained in the largest meta-analyses. The most studied cognitive domains were attention, executive functions, memory, processing speed and working memory. All reviews had methodological issues and were rated as having a high or an unclear risk of bias.

Conclusions: Type 2 diabetes appears to be associated with lower cognitive performance in several cognitive domains and in different age groups. However, high-quality meta-analyses on the subject are still needed. Future reviews must follow the PRISMA guidelines and take into account the risk of bias of the original studies through sensitivity analyses and the heterogeneity of the studies by conducting subgroup analyses for example according to age group and disease duration. The meta-analyses that aim to study the entire type 2 diabetes population without excluding severe comorbidities, should assess concept formation and reasoning, construction and motor performance, perception, and verbal functions and language skills in addition to the cognitive domains that have been most frequently analysed in the reviews conducted so far.

Background: The systematic aggregation of research on cognitive behavioral therapy (CBT) in chronic fatigue syndrome (CFS) needs an update. Although meta-analyses evaluating interventions typically focus on symptom reduction, they should also consider indicators of treatment acceptability, e.g., drop-out rates.

Methods: Randomized controlled trials (RCTs) investigating CBT in adults with CFS compared to inactive and non-specific control groups were included. First, efficacy was examined, considering fatigue, depression, anxiety, and perceived health. Secondly, drop-out rates through different trial stages were analyzed: Non-completion of all mandatory sessions, drop-out (primary study definition), treatment refusal (non-starters), and average of sessions completed.

Result: We included 15 RCTs with 2015 participants. CBT was more effective than controls in fatigue (g = -0.52, 95%CI -0.69 to -0.35), perceived health, depression, and anxiety at post-treatment. At long-term follow-up the effects were maintained for fatigue and anxiety. Rates of non-completion (22%, 95%CI 3-71), drop-out (15%, 95%CI 9-25), and treatment refusal (7%, 95%CI 3-15) were relatively low, with a high average proportion of sessions completed. Total time of therapy moderated the effect on fatigue, while the number of sessions moderated the effect on perceived health. Fatigue severity influenced adherence.

Conclusion: The results indicate that CBT for CFS is effective in reducing fatigue, fatigue related impairment, and severity of depression and anxiety. Conclusions on efficacy at follow-ups are still limited. However, adherence is high in CBT. The results may help to inform clinical practice. Future research should focus on examining the maintenance of effects, while also emphasizing the importance of treatment acceptance.

Background: Interventions that use the Health Action Process Approach (HAPA) model show promise for increasing PA frequency, duration, and intensity. However, there is limited understanding of how HAPA model variables have been operationalized for PA interventions in chronic disease to promote behavior change and sustained PA or whether the phase or continuous form of the HAPA model was used. The aim of this scoping review is to describe how the HAPA model variables for PA interventions were operationalized and provide details of implementation.

Method: We searched five databases to identify studies published between January 1992 and March 2024. We aimed to describe (1) the characteristics of interventions including setting, delivery mode, duration, and content; (2) which HAPA variables were operationalized and the strategies used; and (3) the physical activity measures and outcome effects.

Results: The search identified 23 interventions in 30 papers (12 protocols, 3 quasi-experimental studies, and 15 randomized controlled trials (RCTs)). Seven of the 15 RCTs reported significant positive effects of the HAPA model on PA behavior outcomes. Interventions operationalized between three and nine HAPA constructs showed significant variability in how the HAPA model is used in intervention research. PA measures varied from self-report to validated objective instruments.

Conclusion: We found a lack of clarity in decisions about which HAPA constructs were included in interventions. The wide variability in operationalized HAPA constructs made it challenging to compare interventions. Researchers should provide more detail about intervention design and implementation procedures to enhance transparency.

Background: Chronic pelvic pain (CPP) in women is a debilitating condition with symptoms that affect both medical and psychological systems, yet for those with idiopathic CPP (i.e., those without a known physiologic cause), no consensus for intervention exists.

Aim: A systematic review was conducted to identify the effectiveness of current biomedical, psychosocial, and integrative interventions for idiopathic CPP (ICPP).

Method: Five databases (PubMed, CINAHL, Cochrane, PsycInfo, Web of Science) were systematically searched with multiple keywords for publications from 2008-2022. Articles were coded for sample characteristics, research design, type of intervention, and intervention outcomes.

Results: Nineteen studies met criteria. The majority of the interventions (14 studies) were biomedical, either invasive (e.g., injections), or non-invasive (e.g., medications). Five studies evaluated integrative interventions that combined biomedical and psychosocial components (e.g., a multimodal pain treatment center). Invasive biomedical interventions were better at relieving short-term pain and non-invasive biomedical interventions were superior for long-term pain; integrated interventions reduced both short-term and long-term pain. Integrative interventions also improved mental health, sexual health, and QOL.

Conclusion: Although most interventions for ICPP have been biomedical, integrative interventions showed greater outcome effectiveness, suggesting a focus on integrative interventions in the future.

Background: Understanding how individuals currently perceive healthy eating is essential for developing food policies and dietary recommendations that improve the health and well-being of populations. The purpose of this qualitative evidence synthesis was to systematically outline the views and understandings of healthy eating, focusing on how foods are classified as healthy and unhealthy and what meanings are attached to food and eating by the general adult population in high-income countries.

Methods: A systematic search of four electronic databases was conducted and yielded 24 relevant primary qualitative studies of generally healthy, community-dwelling adults.

Results: Thematic synthesis of the included studies identified three analytic themes: constructions of healthy and unhealthy eating, considerations on dietary recommendations, and meanings attached to food and eating. Study participants generally understood what constitutes a healthy and unhealthy diet which was in line with dietary recommendations, but those of lower socioeconomic status exhibited gaps in nutrition knowledge. Participants expressed diverse opinions on dietary recommendations, including skepticism and a lack of trust. Food and eating were associated with various meanings, including pleasure, stress relief, and feelings of guilt. Moral, health, and sociocultural considerations also played a role in dietary behaviors.

Conclusions: The findings suggest that improving population diet requires considering how dietary recommendations are phrased and communicated to ensure that healthy eating is associated with pleasure and immediate well-being. This review provides valuable insights for developing consumer-oriented, practicable, and acceptable food policies and dietary recommendations that effectively improve population health and well-being.

Background: Resistance training (RT) has been identified as an important lifestyle activity for health. While systematic reviews have examined behavior change techniques (BCTs) used in interventions and potential correlates of RT behavior, the connection between BCTs and changes in putative mediators and RT participation have yet to be linked. The purpose of this review was to examine RT intervention effects, as coded by BCT clusters, on behavior change via capability, opportunity, and motivation as putative mediators of that change.

Method: Literature searches were concluded in January of 2023, using three databases. Eligible studies included a comparison group, assessed RT as an outcome, included BCTs, assessed potential mediators, and were in English. The initial search yielded 1050 hits, which was reduced to 5 to independent RT interventions. Screening of previous reviews yielded three additional papers for a total of 8 papers. Each paper was assessed for the associations between intervention effects (as BCT clusters) on mechanisms of action (a path), effects of mechanisms of action on behavior (b path), and indirect (ab path) and direct (c path) effects of BCT clusters.

Results: There was support that interventions had significant effects on capability and opportunity with inconclusive effects on motivation (a path). Both capabilities and motivation had associations with RT behavior (b path). The examined studies showed that changes in capabilities have the strongest support as a mediator with some support for motivation as a mediator (ab path). Studies that used more BCT clusters seemed to have a more positive effect on behavior, yet there were no trends to suggest any one crucial BCT cluster (c path).

Conclusion: Current evidence suggests that capabilities and motivation are important to target in RT interventions. Future interventions would be well suited to utilize behavior change techniques that address these mediators.

Background: Psychological distress can significantly obstruct the treatment outcomes of patients with psoriasis. This meta-analysis aimed to examine the effects of psychological intervention on the mental health and functional capabilities in patients with psoriasis.

Method: PubMed, EMBASE, and Cochrane Library were searched for relevant studies published up to May 1, 2023. The primary outcome was a change in anxiety, depression, and quality of life (QoL). Standardized mean difference (SMD) was calculated, and 95% confidence interval (CI) was determined for the estimation.

Results: This meta-analysis involved 1048 subjects, including 515 patients who received psychological interventions and 533 patients in control groups who did not receive psychological interventions. The results showed that psychological intervention significantly improved anxiety symptoms (SMD - 0.41; 95%CI - 0.77, - 0.05; I² = 71.5%; P_{Heterogeneity} = 0 .001). There was no significant improvement in the symptoms of depression (SMD - 0.52; 95%CI - 1.13, 0.10; I² = 86%; P_{Heterogeneity} < 0 .001) and QoL (SMD - 0.05; 95%CI - 0.22, 0.11; I² = 39%; P_{Heterogeneity} = 0 .108) in patients who received psychological intervention compared with controls.

Conclusion: Psychological intervention ameliorated anxiety symptoms in patients with psoriasis but had no significant impact on depression or QoL.

Background: As the mental well-being of billions of people is at risk due to the impacts of climate change, more research is required to better understand the psychological implications of climate vulnerability. This research aims to describe the coping strategies of a climate change affected population and the consequences of adaptation behavior.

Method: We conducted 60 qualitative in-depth interviews to elicit the lived experiences of climate-vulnerable men and women in Bhola, Bangladesh. Interviews were analyzed following the tenets of Grounded Theory.

Results: Identified coping strategies included "resignation" or "help-seeking" as well as barriers to coping, such as limited "efficacy," limited "time," or "stigma," which constrained participants - especially women - in their coping behavior.

Conclusion: Our results indicate that certain barriers can lead people to pursue more easily accessible coping strategies, some of which can be interpreted as maladaptive. It is therefore recommended to lift barriers to coping through community-led interventions, such as platforms for sharing problems and knowledge regarding coping strategies.

Background: More than two-thirds of Australians are overweight. Existing research based on non-experimental data has primarily established associations, rather than causal inferences, between physical activity (PA) and body mass index (BMI). PA and BMI likely affect each other, a reciprocal interplay most studies overlook. We investigate the causal relationship between PA and BMI using a quasi-experimental approach to overcome reverse causality bias.

Method: A maximum likelihood treatment effect model, a quasi-experimental method, was employed. Data was from an observational longitudinal dataset of 130,397 observations with 19,677 unique individuals aged 15-64 (52% are females) from the Household, Income, and Labour Dynamics in Australia survey 2006-2019. We first tested for the reverse relationships (whereby overweight limits PA) before estimating the effect of PA on BMI.

Results: The first-stage modelling results showed that overweight and obese adults are less likely to engage in PA, as are those resource constrained (time or socioeconomically). In the second modelling stage, there was a clear and significant effect of PA on BMI. Being physically active more than three times a week led to a 2.55-point reduction in BMI (p < 0.001). For women, this effect was more pronounced, with a 2.92-point reduction (p < 0.001).

Conclusion: This study leverages existing longitudinal data to provide causal estimates of PA on BMI-finding that PA reduces BMI, particularly for women. As many individuals face resource constraints, campaigns to promote behavioural change need to be nuanced and shift some of the responsibility for physically activity from individuals to policy and organizational reforms.