Affect Intervention Effectiveness Research Articles

Scalable and successful patient portal lifestyle coaching training for primary care clinical staff.

Maintaining a healthy weight postintentional weight loss is crucial for preventing chronic health conditions, yet many regain weight postintervention. Electronic health record (EHR) portals offer a promising avenue for weight management interventions, leveraging patient-primary care relationships. Our previous research demonstrated that coaching alongside self-monitoring improves weight maintenance compared to monitoring alone. Integrating weight management into routine clinical practice by training existing staff could enhance scalability and sustainability. However, challenges such as inconsistent staff qualifications and high coach turnover rates could affect intervention effectiveness. Standardizing services, training, and coaching continuity seem crucial for success. To report on developing, testing, and evaluating an EHR-based coaching training program for clinical staff, guided by an implementation tool for the MAINTAIN PRIME study. Conducted across 14 University of Utah primary care sites, we developed, tested, and evaluated a coaching training for clinical staff. Guided by a planning model and the Predisposing, Enabling, and Reinforcing (PER) tool, stakeholders actively participated in planning, ensuring alignment with clinic priorities. All clinical staff were invited to participate voluntarily. Evaluation measures included staff interest, training effectiveness, confidence, and readiness. Data collection utilized REDCap, with survey results analyzed using descriptive statistics. Despite increased clinical workload and reassignments posed by coronavirus disease 2019, we were able to train 39 clinical staff, with 34 successfully coaching patients. Feedback indicated high readiness and positive perceptions of coaching feasibility. Coaches reported satisfaction with training, support, and enjoyed establishing connections with patients. The PER strategies allowed us to implement a well-received training program found effective by primary care coaches.

A positive affect intervention alters leukocyte DNA methylation in sexual minority men with HIV who use methamphetamine

ObjectiveThis epigenomics sub-study embedded within a randomized controlled trial examined whether an evidenced-based behavioral intervention model that decreased stimulant use altered leukocyte DNA methylation (DNAm). MethodsSexual minority men with HIV who use methamphetamine were randomized to a five-session positive affect intervention (n = 32) or an attention-control condition (n = 21), both delivered during three months of contingency management for stimulant abstinence. All participants exhibited sustained HIV virologic control – an HIV viral load less than 40 copies/mL at baseline and six months post-randomization. The Illumina EPIC BeadChip measured leukocyte methylation of cytosine-phosphate-guanosine (CpG) sites mapping onto five a priori candidate genes of interest (i.e., ADRB2, BDNF, FKBP5, NR3C1, OXTR). Functional DNAm pathways and soluble markers of immune dysfunction were secondary outcomes. ResultsCompared to the attention-control condition, the positive affect intervention significantly decreased methylation of CpG sites on genes that regulate β2 adrenergic and oxytocin receptors. There was an inconsistent pattern for the direction of the intervention effects on methylation of CpG sites on genes for glucocorticoid receptors and brain-derived neurotrophic factor. Pathway analyses adjusting for the false discovery rate (padj < 0.05) revealed significant intervention-related alterations in DNAm of Reactome pathways corresponding to neural function as well as dopamine, glutamate, and serotonin release. Positive affect intervention effects on DNAm were accompanied by significant reductions in the self-reported frequency of stimulant use. ConclusionsThere is an epigenetic signature of an evidence-based behavioral intervention model that reduced stimulant use, which will guide the identification of biomarkers for treatment responses.

Development and application of the Demands for Population Health Interventions (Depth) framework for categorising the agentic demands of population health interventions

BackgroundThe ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations.MethodsWe systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in harvest plots.ResultsThe Depth framework identifies three constructs influencing agentic demand: exposure — initial contact with intervention (two levels), mechanism of action — how the intervention enables or discourages behaviour (five levels) and engagement — recipient response (two levels). When combined, these constructs form a matrix of 20 possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness.ConclusionsThis framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis.

Explaining differential socioeconomic effects in population health interventions: development and application of a new tool to classify intervention agentic demand

BackgroundThe agentic demand of population health interventions (PHIs) might influence how interventions work. Highly agentic interventions (eg, information campaigns) rely on recipients noticing and responding to the intervention. Resources required for individuals to benefit from highly agentic interventions have a socioeconomical pattern, thus agentic demand might affect intervention effectiveness and equity. Systematic evidence exploring these associations is missing due to the absence of adequate tools to classify agentic demands. We aimed to develop such a tool and test its application. MethodsOur iterative development process involved: (1) systematic identification of diet and physical activity PHIs; (2) coding of intervention actors and actions; (3) data synthesis; (4) expert qualitative feedback; and (5) reliability assessment. We searched nine databases for articles published between Jan 1, 2010, and Aug 17, 2020. For all included articles, we coded the actors (people required to act within an intervention) and their actions (what they were required to do for the intervention to have its intended effects). We combined these codes for similar intervention types to develop overarching schematic flow chart diagrams used to identify concepts, and we organised these into a draft tool. After expert feedback, and we assessed inter-rater reliability of the final version. We applied the final tool in a proof-of-concept review, extracting studies from three existing equity-focused systematic reviews on tool category, overall intervention effect, and differential socioeconomic effects and visualised findings. FindingsWe identified three concepts affecting agentic demands of intervention components: exposure, two levels (how recipients encounter the intervention); mechanism of action, five levels; and engagement, two levels (how recipients respond to the intervention). We then combined these concepts to form 20 categories that grouped together interventions with similar agentic demands. In the review, we applied the tool to 26 PHIs that included 163 components. Intervention components were concentrated in a small number of categories, and their categorisation was related to intervention equity but not to effectiveness. InterpretationWe present a novel tool to classify the agentic demand of PHIs and demonstrate its feasibility within a systematic review. Linking intervention types to their effect on inequalities enables these factors to be considered when designing or selecting interventions. Users of the tool can avoid implementing intervention types that are likely to widen inequalities or implement them alongside counter-strategies to minimise any adverse equity effects. Applying this tool within future research, policy, and practice to design, select, evaluate, and synthesise evidence from PHIs has the potential to advance our understanding of how interventions work and their effect on socioeconomic inequalities. FundingPublic Health Policy Research Unit (PH-PRU), National Institute for Health and Care Research (NIHR) Policy Research Programme.

A feasibility study on home-based kyphosis-specific exercises on reducing thoracic hyperkyphosis in older adults

ObjectivesThis study aimed to assess the feasibility of the home-based kyphosis-specific exercises among Chinese older adults with different exercise habits and explore its potential effects on reducing the kyphosis angle and improving physical performance. MethodsA single-group, pre-and post-test design was conducted according to CONSORT 2010 statement: extension for pilot and feasibility trials. A total of 20 participants aged ≥60 with thoracic hyperkyphosis and rehabilitation potential were recruited from four local communities in Wuhan, China. Participants underwent a six-week home-based kyphosis-specific exercises intervention that included warm-up, muscle strengthens, spinal alignment, spinal mobility and flexibility, and cool down five sections (22 exercises). The intervention involved seven 1-h group classes and 35 times daily home practice with identical content. At pre- and post-intervention, the participants' kyphosis angle in two standing postures, static balance, dynamic balance, cardiopulmonary function, dynamic gait assessment, pain, and self-image were assessed and compared. Feasibility was assessed by group class attendance, home practice adherence, and participant evaluations. ResultsAll participants completed group classes and >75% home practice. Post-intervention, the participant’s kyphosis angle in relaxed and best-standing postures was changed by −12.0° (−15.5°, −4.0°) (Z = − 3.98, P < 0.001）and −10.0° (−14.0°, −5.3°) (Z = −3.79, P < 0.001), respectively. In addition, participants had significantly less pain (P < 0.001), better self-image (P < 0.001), and improved performance in five physical assessments (P < 0.01). Different pre-intervention hyperkyphosis angle and daily physical activity did not affect intervention effects. Most participants considered the interventional exercise as moderate intensity and satisfactory. ConclusionsHome-based kyphosis-specific exercises showed the possibility of being a feasible intervention. And it was advantageous to reducing the kyphosis angle and improving physical performance.

Dignity Therapy Led by Nurses or Chaplains for Elderly Cancer Palliative Care Outpatients: Protocol for a Randomized Controlled Trial.

BackgroundOur goal is to improve psychosocial and spiritual care outcomes for elderly patients with cancer by optimizing an intervention focused on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document. These tasks are central needs for elderly patients with cancer. Dignity therapy (DT) has clear feasibility but inconsistent efficacy. DT could be led by nurses or chaplains, the 2 disciplines within palliative care that may be most available to provide this intervention; however, it remains unclear how best it can work in real-life settings.ObjectiveWe propose a randomized clinical trial whose aims are to (1) compare groups receiving usual palliative care for elderly patients with cancer or usual palliative care with DT for effects on (a) patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness); and (b) processes of delivering palliative spiritual care services (satisfaction and unmet spiritual needs); and (2) explore the influence of physical symptoms and spiritual distress on the outcome effects (dignity impact and existential tasks) of usual palliative care and nurse- or chaplain-led DT. We hypothesize that, controlling for pretest scores, each of the DT groups will have higher scores on the dignity impact and existential task measures than the usual care group; each of the DT groups will have better peaceful awareness and treatment preference more consistent with their cancer prognosis than the usual care group. We also hypothesize that physical symptoms and spiritual distress will significantly affect intervention effects.MethodsWe are conducting a 3-arm, pre- and posttest, randomized, controlled 4-step, stepped-wedge design to compare the effects of usual outpatient palliative care and usual outpatient palliative care along with either nurse- or chaplain-led DT on patient outcomes (dignity impact, existential tasks, and cancer prognosis awareness). We will include 560 elderly patients with cancer from 6 outpatient palliative care services across the United States. Using multilevel analysis with site, provider (nurse, chaplain), and time (step) included in the model, we will compare usual care and DT groups for effects on patient outcomes and spiritual care processes and determine the moderating effects of physical symptoms and spiritual distress.ResultsThe funding was obtained in 2016, with participant enrollment starting in 2017. Results are expected in 2021.ConclusionsThis rigorous trial of DT will constitute a landmark step in palliative care and spiritual health services research for elderly cancer patients.Trial RegistrationClinicalTrials.gov NCT03209440; https://clinicaltrials.gov/ct2/show/NCT03209440International Registered Report Identifier (IRRID)DERR1-10.2196/12213

Interrelations between participant and intervention characteristics, process variables and outcomes in online interventions: A protocol for overarching analyses within and across seven clinical trials in ICare

BackgroundIt is well known that web-based interventions can be effective treatments for various conditions. Less is known about predictors, moderators, and mediators of outcome and especially interrelations between participant and interventions characteristics, process variables and outcomes in online interventions. Clinical trials often lack statistical power to detect variables that affect intervention effects and their interrelations. Within ICare, we can investigate the interrelation of potential predictor and process variables in a large sample. MethodThe ICare consortium postulated a model of interrelations between participant and intervention characteristics, process variables and outcomes in online interventions. We will assess general and disorder-specific interrelations between characteristics of the intervention, characteristics of the participants, adherence, working alliance, early response, and intervention outcomes in a sample of over 7500 participants from seven clinical trials evaluating 15 online interventions addressing a range of mental health conditions and disorders, using an individual participant data meta-analyses approach. Discussion/conclusionExisting research tends to support the efficacy of online mental health interventions, but the knowledge base regarding factors that affect intervention effects needs to be expanded. The overarching analyses using data from the ICare intervention trials will add considerably to the evidence.

Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh.

Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming.

The effect of choice on motivation for young children on the autism spectrum during discrete trial teaching

Self‐determination and decision‐making are acknowledged internationally as key rights of persons with disabilities and should play an important role in the development of educational plans and procedures. Not only is the chance for individuals with developmental disabilities to select their own tasks, leisure activities or reinforcers a valuable way of enhancing rights‐based education and personal dignity, but choice‐making opportunities may also function as a useful clinical or educational tool if they actually improve the efficacy of programmes aimed at the acquisition of socially relevant behaviours and life skills or the reduction of challenging behaviours.The study reported here assessed whether or not choice affected effectiveness of an educational procedure for three children on the autism spectrum. Following a preference assessment, a number of discrete teaching trials were conducted with each child and, contingent upon targeted responses, either the child or the therapist selected one of three preferred reinforcer items. Reinforcer choice did not affect intervention effectiveness for two of the children; however, performance and motivation improved for the third child. Results re‐affirmed the importance of thorough preference assessments prior to intervention and showed that additional stimulus choice contingent on the target response may improve motivation and outcomes for some children.

Does smoking within an individual's peer group affect intervention effectiveness? An evaluation of the Smoke-Free Class Competition among Swiss adolescents

ObjectiveThe aim of this study is to test whether participation in the Smoke-Free Class Competition (SFC), a classroom-based smoking prevention program, reduced smoking and increased smoking-related knowledge among those with and without smoking peers compared to control groups. MethodIncluding smoking peers as a moderator in multilevel models, a quasi-experimental design with a post-test at seven months was used to analyze data from 1035 students in Switzerland (2011; mean age 13.3, 53.2% female). ResultsCompleting the SFC decreased smoking prevalence (OR=0.7; CI=0.5–1.0; ns) and increased smoking-related knowledge (b=1.0; p<.01) compared to control classes. However, the former effect was only significant among those without smoking peers (OR=0.3; CI=0.2–0.5; p<.001). With smoking peers, smoking prevalence was even higher at post-test (OR=3.7; CI=1.7–8.2; p<.01) in the classes that completed SFC compared to controls. No effect was found in classes that started SFC but had to pull out. ConclusionsThe results indicate that SFC should be applied early in adolescence, when individuals are less likely to have classmates who smoke and are therefore less likely to have to pull out of the program. This is particularly important because SFC was only effective among those who completed the program and did not have smoking peers.

Adaptations to the coping power program's structure, delivery settings, and clinician training.

This article describes the conceptual framework for the Coping Power program that has focused on proximal risk factors that can actively alter preadolescent children's aggressive behavior. The results of initial controlled efficacy trials are summarized. However, consistent with the theme of this special section, some clinicians and workshop participants have indicated barriers to the implementation of the Coping Power program in their service settings. In response to these types of concerns, three key areas of programmatic adaptation of the program that serve to address these concerns are then described in the article. First, existing and in-process studies of variations in how the program can be delivered are presented. Existing findings indicate how the child component fares when delivered by itself without the parent component, how simple monthly boosters affect intervention effects, and whether the program can be reduced by a third of its length and still be effective. Research planned or in progress on program variations examines whether group versus individual delivery of the program affects outcomes, whether the program can be adapted for early adolescents, whether the program can be delivered in an adaptive manner with the use of the Family Check Up, and whether a brief, efficient version of the program in conjunction with Internet programming can be developed and be effective. Second, the program has been and is being developed for use in different settings, other than the school-based delivery in the efficacy trials. Research has examined its use with aggressive deaf youth in a residential setting, with Oppositional Defiant Disorder and Conduct Disorder children in outpatient clinics, and in after-school programs. Third, the article reports how variations in training clinicians affect their ability to effectively use the program.

Policy implementation: Implications for evaluation

AbstractPolicy implementation reflects a complex change process where government decisions are transformed into programs, procedures, regulations, or practices aimed at social betterment. Three factors affecting contemporary implementation processes are explored: networked governance, sociopolitical context and the democratic turn, and new public management. This frame of reference invites evaluators to consider challenges present when evaluating macrolevel change processes, such as the inherent complexity of health and social problems, multiple actors with variable degrees of power and influence, and a political environment that emphasizes accountability. The evaluator requires a deep and cogent understanding of the health or social issues involved; strong analysis and facilitation skills to deal with a multiplicity of values, interests, and agendas; and a comprehensive toolbox of evaluation approaches and methods, including network analysis to assess and track the interconnectedness of key champions (and saboteurs) who might affect intervention effects and sustainability. © Wiley Periodicals, Inc., and the American Evaluation Association.