Annals of Behavioral Medicine最新文献

Background: Previous research has examined the deleterious impact of racial stress on African Americans' mental and physical health; however, few interventions have focused on utilizing culturally salient protective factors to buffer the effect of racial stress on physical health outcomes.

Purpose: This pilot feasibility trial assessed the preliminary impact of Linking Exercise for Advancing Daily Stress (LEADS) Management and Resilience, a cultural and family-based resilience intervention aiming to increase physical activity and improve coping in overweight African American adolescents (N = 23 adolescent-caregiver dyads; adolescent Mage 14.0 ± 2.2; MBMI percentile 97.8; 61.9% female; Parents Mage 46.4 ± 8.8; MBMI 41.2 ± 7.6; 100.00% female).

Methods: The 10-week feasibility trial tested an online family-based group resilience and health promotion program compared to an online health education only program.

Results: Process evaluation demonstrated high feasibility and acceptability of both group programs. As hypothesized, among adolescents, the treatment means reflect an average increase of 4.31 min/day of moderate-to-vigorous physical activity in the intervention group compared to an average decrease of 7.84 min/day of moderate-to-vigorous physical activity in the health education group. For light physical activity, treatment means reflect an average increase of 11.08 min/day in the intervention group and an average decrease of 2.56 min/day in the health education group. Also, the intervention adolescents and parents had greater engagement in adaptive coping skills (active coping, religion to cope, cognitive reframing) from baseline to post-treatment than the health education group, and greater reductions in maladaptive, and passive coping skills (self-distraction) than the health education group.

Conclusions: This pilot feasibility trial demonstrates the acceptabity and feasibiity of integrating culturally sensitive strength-based interventions for African American families to promote health promotion behaviors and coping.

Background: Fatigue is a prevalent and debilitating symptom among kidney transplant candidates (KTCs), significantly affecting their quality of life and overall well-being. Its complexity necessitates a comprehensive approach to manage fatigue in this population.

Purpose: To explore the effectiveness of nonpharmacological interventions in reducing fatigue in KTCs.

Methods: Nonpharmacological interventions targeting fatigue in participants aged ≥18 years, who were either on the kidney transplantation waitlist or eligible candidates, were considered. A database search was conducted in PubMed, Embase, PsycINFO, CINAHL, and Web of Science. Results were reported in accordance with the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews Checklist.

Results: In total, 67 studies were included. Interventions were divided into manipulative and body-based practices, exercise, mind-body therapies, energy healing, and combined interventions. Thirty-eight studies (76%) demonstrated a significant effect on fatigue, with effect sizes ranging from 0.43 to 4.85. Reflexology, massage therapy, progressive muscle relaxation, and acupressure combined with massage therapy showed the strongest significant intervention effects on fatigue and had the strongest study quality. However, the overall study quality was weak, particularly concerning confounding control, blinding procedures, and withdrawals and dropouts.

Conclusions: Manipulative and body-based interventions showed the strongest significant effects on fatigue with the highest study quality. These interventions underscore the multifactorial nature of fatigue by targeting both its physical and psychological dimensions. Future high-quality research is needed to determine the optimal strategy for managing fatigue in KTCs.

Background: Black and Hispanic prostate cancer (PCa) survivors, who face a high burden of comorbid conditions and often engage in low levels of physical activity and healthy eating, remain significantly underrepresented in lifestyle intervention studies.

Purpose: Given the significance of spousal influence, we developed a culturally tailored lifestyle intervention for these survivors and their spouses and assessed its feasibility, acceptability, and impact on behavioral change.

Methods: Survivor-spouse couples were randomly assigned to an intervention group (n = 22), which received 12 health-coaching calls over 6 months, or a usual-care control group (n = 9). Assessments were conducted at baseline (T1), mid-intervention (T2, month 3), and post-intervention (T3, month 6).

Results: The mean attendance was 10.58 sessions, and the intervention received high acceptability scores. Assessment completion rates were 84% at T2 and 81% at T3 for survivors, and 77% at T2 and 81% at T3 for spouses. Intervention group survivors showed meaningful improvements in diet quality from T1 to T2 (+ 6.56) and a clinically important increase in moderate-to-vigorous physical activity (MVPA) from T1 to T3 (+ 17.5 min/day on average). Intervention group spouses also showed meaningful improvements in diet quality from T1 to T2 (+ 8.19) and from T1 to T3 (+ 6.34) and MVPA from T1 to T3 (+ 17.3 min/day on average). Control group participants showed improvements in MVPA.

Conclusions: This couple-based lifestyle intervention is feasible, highly accepted, and promising for improving healthy lifestyle behaviors among Black and Hispanic PCa survivors and their spouses. The results should be carefully interpreted and replicated in an adequately powered trial.

Background: Despite the demonstrated efficacy of coronavirus disease (COVID-19) vaccines, higher rates of vaccine hesitancy among African Americans remain concerning. As determinants of vaccine hesitancy, the simultaneous roles of government mistrust and group-based medical mistrust have not been examined via from a cognitive information perspective among African Americans.

Purpose: We examined the direct and indirect effects of government mistrust and group-based medical mistrust on COVID-19 vaccine hesitancy in a sample of African Americans.

Methods: We obtained data from 382 African Americans in South-East Michigan via an online survey. We assessed demographic variables, government mistrust, group-based medical mistrust, COVID risk and COVID worry, and positive and negative beliefs regarding the COVID-19 vaccine (i.e., vaccine pros and cons), and vaccine hesitancy. We examined our hypotheses with path analyses.

Results: Results indicated significant direct effects of government mistrust on vaccine hesitancy; however, despite a significant correlation, there was no direct effect of group-based medical mistrust on vaccine hesitancy. The effect of group-based medical mistrust was fully mediated by both vaccine pros and cons, whereas the effect of government mistrust was partially mediated by vaccine pros. COVID risk and COVID worry did not mediate the effects of mistrust to vaccine hesitancy.

Conclusion: Negative effects of group-based medical mistrust on COVID-19 vaccine hesitancy among African Americans may be amenable to interventions that focus on beliefs about the vaccine rather than beliefs about vulnerability to the virus. However, given its direct effect, it may be necessary to focus directly on government mistrust to diminish its effects on COVID-19 vaccine hesitancy.

In the classical paradigm for intervention research, the components that are to make up an intervention are identified, pilot tested, and then immediately assembled into a treatment package and subjected to an evaluation randomized controlled trial (RCT) to assess the performance of the entire package. Intervention optimization, which adapts ideas from technological fields to intervention science in order to hasten scientific progress, is an alternative to the classical paradigm. The first article introducing intervention optimization via the multiphase optimization strategy (MOST) was published in Annals of Behavioral Medicine in 2005. In this commentary, I reflect on the evolution of intervention optimization from that first publication to today, and on what the future could hold if the intervention science field continues to adopt the optimization paradigm. I propose that if intervention optimization became standard operating procedure, the field would accumulate a coherent base of knowledge about what specific intervention strategies work, for whom, under which circumstances, and why; every intervention produced would contain only components that contribute enough to justify their resource requirements; interventions would be readily implementable; and as the knowledge base grew, interventions would be improved continually.

Background: The close relationship processes and health model and the dyadic health influence model posit that relationship beliefs (eg, relationship satisfaction) and influence strategies (eg, provision and receipt of positive and negative social control) mediate health behavior change. However, evidence for such mediation in parent-child dyads is limited.

Purpose: Two complementary mediation hypotheses were tested: (1) social control forms indirect relationships with sedentary behavior (SB), via relationship satisfaction acting as a mediator; and (2) relationship satisfaction forms indirect relationships with SB, with social control operating as a mediator.

Methods: Data from 247 parent-child dyads (9- to 15-year-old children) were analyzed using manifest mediation models. SB was measured with GT3X-BT accelerometers at Time 1 (T1; baseline) and Time 3 (T3; 8-month follow-up). Relationship satisfaction and social control were assessed at T1 and Time 2 (T2; 2-month follow-up). Path analysis models, controlling for baseline SB, were fit.

Results: Received positive control (children, T1) was associated with higher relationship satisfaction in both children and parents (T2), which in turn were related to lower and higher parental SB at T3, respectively. Provided positive control (parents; T1) was related to higher SB (T3) in children. Relationship satisfaction among children (T1) predicted higher levels of received positive and negative control (children, T2).

Conclusions: Provided and received positive social control may form direct and indirect associations with SB in parent-child dyads. Future research may need to consider further subtypes of positive control, which may explain the divergent effects of this form of control on SB.

Background: Self-affirmation theory (SAT) and acceptance and commitment therapy (ACT) embody competing approaches to leveraging personal values to motivate behavior change but are rarely compared in the domain of health behavior. This study compares these theory-driven values-based interventions for promoting medication adherence.

Purpose: To compare affective and behavioral responses to competing values-based medication adherence interventions.

Methods: In this three-armed randomized trial, participants with cancer (n = 95) or diabetes (n = 97) recruited online using Prolific and prescribed daily oral medication for that disease completed a one-session online writing intervention leveraging (1) a domain incongruent (DI) value, where the value was not connected to medication adherence; (2) a domain congruent (DC) value, where the value was connected to adherence; or (3) a control condition, focused on medication adherence procedures.

Results: There were no main effects of conditions on reported medication adherence at the 1-month follow-up. During the intervention, positive affect was higher in the values conditions than control (p < .001), and trended higher in DI versus DC (p = .054). Negative affect did not vary between the values and control groups (p = .093) but was lower in DI versus DC (p = .006). Improvements in positive affect over the course of the intervention were associated with increased adherence behavior for individuals who started with low levels of positive affect (p = .003). Disease type did not moderate findings.

Conclusions: Consistent with SAT, focusing on DI values led to more positive and less negative affect than connecting values directly to behavior in a threatening domain such as chronic illness. For some participants, increases in positive affect predicted greater adherence.

Background: Patients' negative expectations about medication can exacerbate side effect burden leading to low adherence and persistence. A novel intervention involves targeting mindsets about non-severe symptoms; reframing them as encouraging signs of medication working.

Purpose: This study aimed to assess whether a brief symptom-mindset intervention can improve symptom experience and adherence in patients starting methotrexate to treat an inflammatory rheumatic disease.

Methods: A randomized controlled trial was conducted with patients starting methotrexate. Participants were randomly assigned (1:1) to a mindset intervention or standard information control condition. Symptom mindset was assessed after 4 weeks to check intervention efficacy. The primary outcome was symptom experience after 4 weeks. Secondary outcomes were adherence and motivation to take methotrexate (4 weeks), as well as continuation and C-reactive protein (12 weeks).

Results: Forty-seven participants were randomly assigned to the intervention (n = 24) or control group (n = 23). All participants completed the study. After 4 weeks, compared to the control group, intervention participants endorsed more positive symptom mindsets, experienced less symptom burden (mean difference -2.70 [95% CI, -4.50, -0.90] P = .005), fewer general symptoms (3.53 [-6.99, .79] P = .045) and a similar number of methotrexate-specific symptoms (-0.79 [-2.29, 0.71] P = .295). The intervention group had better motivation and adherence to methotrexate at 4 weeks and better continuation, and C-reactive protein at 12 weeks than the control group. There was no difference in side effect attribution.

Conclusions: In patients starting methotrexate, a mindset intervention reframing the role of non-severe side effects is a promising approach for improving symptom experience and early stage medication persistence.

Background: Stress plays a pivotal role in physical health. Although many studies have linked stress reactivity (daily within-person associations between stress exposure and negative affect) to physical health outcomes, we know surprisingly little about how changes in stress reactivity are related to changes in physical health.

Purpose: The current study examines how change in stress reactivity over 18 years is related to changes in functional health and chronic health conditions.

Methods: Three measurement bursts from the National Study of Daily Experiences (N = 2880; 55% female) each included daily measures of stressor exposure and negative affect across 8 consecutive days, yielding 33 944 days of data across 18 years of adulthood. At each wave, participants reported their functional health limitations (ie, basic activities of daily living [ADL] and instrumental activities of daily living [IADL]) and chronic health conditions. Multilevel structural equation models simultaneously modeled stress reactivity at Level 1, longitudinal changes in stress reactivity at Level 2, and the association between changes in stress reactivity and changes in functional limitations and chronic conditions at Level 3.

Results: Higher levels of stress reactivity at baseline were associated with more functional health limitations 18 years later (ADLs: Est. = 0.90, P = .001; IADLs: Est. = 1.78, P < .001). Furthermore, individuals who increased more in their stress reactivity across the 18-year period also showed greater increases in their functional health limitations (ADLs: Est. = 4.02, P = .017; IADLs: Est. = 5.74, P < .001) and chronic conditions (Est. = 11.17, P = .008).

Conclusions: These findings highlight the strong connection between health and stress in daily life, and how they travel together across adulthood.