Attended Group Sessions Research Articles

'To loosen up and talk': Patients´ and facilitators´ experiences of discovery group sessions from the Tidal Model as an introduction before engaging in a person-centred group intervention.

Treatment groups in Mental Health Service is cost-effective, increases patients´ self-understanding and stimulate change Research shows that people with mental illness have different barriers to attend group sessions which often originates from a lack of trust in other people, but it is known that the possibility to build gradual trust among the participants encourages attendance. This study is based on the experience from outpatients and illuminates how discovery groups from the Tidal Model can be used as introductory sessions to build gradual trust among people with mental illness before engaging in a person-centred group intervention. The study fills a research gap in methods to create a safe and trusting environment in treatment groups for people with mental illness working with recovery-oriented person-centred interventions. This study emphasizes the importance of meeting concerns about social interactions in persons with mental illness when joining treatment groups. It presents a recovery-oriented method which meets this requirement and is easy to implement in practice. INTRODUCTION: Recovery-oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment. The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person-centred group intervention. A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur's theory of interpretation. The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators. Feeling safe and sharing experiences and emotions contribute to the relational climate in a group. Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality.

Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms.

Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For interventions to be successful, it is important to influence "behavioral mechanisms" such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36 months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed. Participants (n = 962) with overweight and prediabetes who had achieved ≥8% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol. There was no increase in the participants' self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions. The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.

Профилактика и коррекция тревожности, вызванной социальными факторами у студентов

The article revealsthe topic of psycho-correctionand prevention of a high level of personal anxiety in students of 1-2 courses. Previously, a high level of personal anxiety was detected in 81 students. There was a need for psycho-correctivework focused on the development of social interaction skills and reducing the excessive level of self-control. Participants were invited to attend group sessions with a psychologist according to a pre-developed correctional program for 3 months. During the whole time, 26 sessions were conducted with each of the subgroups. 13 sessions were identified for the development of personal communication skills. A similar number of sessions are allocated to reduce the level of requirements for self-identity. After the completion of the psycho-correctionwork, there were obtainedresults indicating a decrease in the overall level of personal anxiety in the study sample. It indicates the effectiveness of the psycho-correctionmeasures. The study participants were given the necessary recommendations for maintaining theirlevel of personal and reactive anxiety.

A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol

BackgroundApproximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity.MethodsThis feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted.DiscussionThis randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients.Trial registrationISRCTN number 22088800.

Mindfulness Techniques as a Means of Developing Reflexivity in Patients with Victim Mentality

The present research featured the effect of mindfulness-based techniques on the development of reflexivity in patients with victim mentality. Mindfulness techniques include such practices as breathing exercises, meditation, progressive relaxation, journaling, visualization, etc. They are believed to develop reflexivity, as well as various useful personal and social responsibility skills. The study was based on O. O. Andronnikova’s methods for studying the victim behavior and the methods for determining reflexivity level by A. V. Karpov and V. V. Ponomarev. The survey (N=208) involved respondents aged 18–23 (145 women, 63 men). Tests revealed 52 subjects with victim mindset. They were divided into experimental (N=25) and control (N=27) groups. The participants attended group sessions of mindfulness-based practices once a week for six months. Based on the results of Mann-Whitney U-criterion and the Wilcoxon signed-rank test, the therapy proved efficient in differentiating the inner world of the participants and improving their conscious functioning in society in the time continuum. The mindfulness techniques promoted the development of reflexivity in patients with victim mentality and decreased self-harming behavior (p=0.045) and aggression (p=0.033).

COVID-19 recovery: benefits of multidisciplinary respiratory rehabilitation

Many patients struggle with ongoing symptoms in different domains (physical, mental, cognitive) after hospitalisation for COVID-19, calling out for a multidisciplinary approach. An outpatient multidisciplinary rehabilitation programme, according to a...

A COMPARATIVE STUDY OF BIRTH PREPAREDNESS AND COMPLICATION READINESS AMONG WOMEN ATTENDING PRENATAL CLINIC IN GEM SUB COUNTY, KENYA

Purpose:To compare the levels of birth preparedness and complication readiness among women receiving group versus those receiving individual prenatal care.
 Methodology: A quasi-experimental study that utilized the pre-test/post-test design with random assignment to either group or individual care. The recruitment of respondents was done over a period of six weeks. The sample size was determined using Pocock’s formulae. During recruitment, 175 respondents were enrolled in the study. 59 respondents were recruited at Malanga, 48 at Nyawara, 35 at Ndere and 33 at Marenyo. This distribution was based on population targets assigned by the Sub-County Health Team and facility performance data retrieved from DHIS. (n = 175).Demographic data were analyzed using descriptive statistics. Bivariate analysis was used to determine and control for any confounders. Differences between control and intervention arms were determined using chi-square and independent samples t-tests. P<0.05 was considered significant.
 Findings:The mean age for both arms was 24.1 years. In the intervention arm, 16% were not married while 84% were married while in the control group 15% and 85% were not married and married respectively. Level of education was matched with those having primary level education being more than half (53%) while those with secondary level education and tertiary level education were 40% and 7% respectively. A total of 32 respondents in the intervention group attended the second prenatal care visit at Malanga, 22 at Nyawara, 12 at Ndere and 15 at Marenyo. During the third visit, 28, 23, 13 and 13 respondents attended group sessions at Malanga, Nyawara, Ndere and Marenyo. Birth preparedness and complication readiness was 17% during pre-test. There was no significant difference in birth preparedness and complication readiness in the intervention and control group (p>0.05). Regarding any form of preparation made, the majority of the clients (91% and 89%) in the intervention and control groups respectively had made some form of preparation. With regards to the identification of a skilled birth attendant, 88% in the intervention and 94% in control had identified a skilled birth attendant.
 Unique Contributions to Theory, Practice and Policy: The study recommends that standards and guidelines for group prenatal care be developed to enable its implementation in prenatal care

Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV

Background Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. Objective Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. Methods Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40–59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. Results Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. Conclusions Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.

Authentic Connections Groups: A Pilot Test of an Intervention Aimed at Enhancing Resilience Among Nurse Leader Mothers.

Nurse leaders who are mothers are at significant risk for experiencing stress, burnout, and occupational fatigue. Authentic Connections (AC) Groups is an intervention shown to be effective for fostering resilience among at-risk moms, including physicians; however, it has not previously been tested with nurse leaders. Our aims were to test the feasibility and acceptability of the AC Groups intervention with nurse leader mothers and examine its effects on participant resilience, as measured by increased self-compassion and decreased distress, depression, perceived stress, and burnout. A randomized controlled trial design was employed for this pilot study, with 36 nurse leaders atMayo Clinic. AC participants attended group sessions for an hour per week for 12weeks. Control group members were provided 1hr per week of free time over 12weeks. Multiple self-report psychological measures were completed at baseline, post-intervention, and 3-month follow-up. The AC Groups intervention was feasible and well-received by nurse leaders. Session attendance rates averaged 92%. Despite the small n's, repeated measures of Analysis of Variance showed significantly greater improvements (p<.05) for participants in the AC Groups than control condition for depression, self-compassion, and perceived stress, with large effect sizes ( 0.18-0.22). In addition, effect sizes for anxiety and feeling loved approximated the moderate range ( 0.05 and .07). The AC intervention shows promise as a feasible intervention for mitigating nurse leader mothers' stress by positively impacting indices of well-being, including depression, self-compassion, and perceived stress. Given, the prevalence of stress and burnout among nurse leaders, the effectiveness of the AC intervention in fostering resilience in this population has significant implications for research and practice. Further research is warranted with larger numbers from multiple sites, longer follow-up periods, and biomarker measures of stress.

Group cognitive rehabilitation to reduce the psychological impact of multiple sclerosis on quality of life: the CRAMMS RCT.

People with multiple sclerosis have problems with memory and attention. The effectiveness of cognitive rehabilitation has not been established. The objectives were to assess the clinical effectiveness and cost-effectiveness of a cognitive rehabilitation programme for people with multiple sclerosis. This was a multicentre, randomised controlled trial in which participants were randomised in a ratio of 6 : 5 to receive cognitive rehabilitation plus usual care or usual care alone. Participants were assessed at 6 and 12 months after randomisation. The trial was set in hospital neurology clinics and community services. Participants were people with multiple sclerosis who had cognitive problems, were aged 18-69 years, could travel to attend group sessions and gave informed consent. The intervention was a group cognitive rehabilitation programme delivered weekly by an assistant psychologist to between four and six participants for 10 weeks. The primary outcome was the Multiple Sclerosis Impact Scale - Psychological subscale at 12 months. Secondary outcomes included results from the Everyday Memory Questionnaire, the 30-Item General Health Questionnaire, the EuroQol-5 Dimensions, five-level version and a service use questionnaire from participants, and the Everyday Memory Questionnaire - relative version and the Modified Carer Strain Index from a relative or friend of the participant. Of the 449 participants randomised, 245 were allocated to cognitive rehabilitation (intervention group) and 204 were allocated to usual care (control group). Of these, 214 in the intervention group and 173 in the control group were included in the primary analysis. There was no clinically important difference in the Multiple Sclerosis Impact Scale - Psychological subscale score between the two groups at the 12-month follow-up (adjusted difference in means -0.6, 95% confidence interval -1.5 to 0.3; p = 0.20). There were no important differences between the groups in relation to cognitive abilities, fatigue, employment, or carer strain at follow-up. However, there were differences, although small, between the groups in the Multiple Sclerosis Impact Scale - Psychological subscale score at 6 months (adjusted difference in means -0.9, 95% confidence interval -1.7 to -0.1; p = 0.03) and in everyday memory on the Everyday Memory Questionnaire as reported by participants at 6 (adjusted difference in means -5.3, 95% confidence interval -8.7 to -1.9) and 12 months (adjusted difference in means -4.4, 95% confidence interval -7.8 to -0.9) and by relatives at 6 (adjusted difference in means -5.4, 95% confidence interval -9.1 to -1.7) and 12 months (adjusted difference in means -5.5, 95% confidence interval -9.6 to -1.5) in favour of the cognitive rehabilitation group. There were also differences in mood on the 30-Item General Health Questionnaire at 6 (adjusted difference in means -3.4, 95% confidence interval -5.9 to -0.8) and 12 months (adjusted difference in means -3.4, 95% confidence interval -6.2 to -0.6) in favour of the cognitive rehabilitation group. A qualitative analysis indicated perceived benefits of the intervention. There was no evidence of a difference in costs (adjusted difference in means -£574.93, 95% confidence interval -£1878.93 to £729.07) or quality-adjusted life-year gain (adjusted difference in means 0.00, 95% confidence interval -0.02 to 0.02). No safety concerns were raised and no deaths were reported. The trial included a sample of participants who had relatively severe cognitive problems in daily life. The trial was not powered to perform subgroup analyses. Participants could not be blinded to treatment allocation. This cognitive rehabilitation programme had no long-term benefits on quality of life for people with multiple sclerosis. Future research should evaluate the selection of those who may benefit from cognitive rehabilitation. Current Controlled Trials ISRCTN09697576. This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 4. See the National Institute for Health Research Journals Library website for further project information.

Kids and Teens in Court (KTIC): A Model for Preparing Child Witnesses for Court.

Each year, numerous children testify in the United States in either criminal, civil, or juvenile court cases. Typically, children who testify are alleged victims of sexual or physical abuse or neglect, witnesses to violent crime, or subjects in custodial hearings in civil court. As more maltreatment cases are prosecuted and child custody is contested, an increasing number of children are being called as witnesses in court. Many of these children have already been traumatized by the experiences that led to their need to testify, and participation in the court process can have additional negative effects. This article describes the development and recent formative evaluation of a court preparation program that provides psychoeducation and utilizes components of evidence-based trauma treatment approaches, such as relaxation and in vivo exposure, to support child witnesses and reduce the risk of retraumatization. Children and adolescents participating in the program attend group sessions conducted by mental health clinicians and complete a court-related anxiety measure before and after each session. Results from 175 participants are reported. Findings indicated significant decreases in court-related anxiety with large program effects. Challenges encountered by the program and future directions are discussed.

Children’s Perspectives on the Experiences of Their Siblings with Chronic Disorders

Knowledge about the experiences of children with chronic disorders (CCD) is often based on parent-report. Obtaining self-report from CCD may be challenging due to cognitive impairments associated with many disorders. We explored siblings’ perspectives on the experiences of their brothers and sisters with CCD, which represent a unique intragenerational and peer-based viewpoint. Siblings of children with various genetic disorders involving physical and/or intellectual disabilities were recruited from family courses at a specialist center for rare disorders. Participants (N = 58; M age= 11.4 years, SD = 2.4; range 7 to 17 years; 69.0% girls) attended group sessions focused on siblings’ diagnostic knowledge and emotional experiences. We conducted a thematic analysis following guidelines for consensual qualitative research of 20 videotaped and transcribed group sessions for 58 siblings of CCD. We interpreted siblings’ perspectives as indicating considerable efforts to understand and reflect upon the state of mind of the CCD along the following main themes: Abilities; Intensions; Insight; Emotions; Personality, preferences and desires; and Normality versus difference. Siblings emphasized CCD’s physical, cognitive, and social abilities, focusing more on strengths than limitations. A desire to be normal and lack of insight were common inferred reasons for problematic behavior displayed by the CCD. Siblings expressed fears of bullying of the CCD. In conclusion, siblings show psychologically complex insights into the experiences and mindsets of CCD and should be considered as informants in research and in informing practice interventions for CCD, alongside their parents.

Delivering a Parenting Program in South Africa: The Impact of Implementation on Outcomes

ObjectivesPrevious studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low- and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings.MethodsThis study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomes – parenting and maltreatment reported by caregivers and adolescents aged 10–18 (N = 270 pairs), 14 outcome constructs.ResultsFidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01).ConclusionsOur study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.

A Feasibility Study to Promote Optimal Weight in First Time Pregnant Mothers and Their Babies: Lessons Learned in a US-Mexico Border Community.

Introduction Obesity rates among US Hispanic women and children are high. Childhood obesity prevention beginning prenatally is desirable, but studies show mixed results. Methods We tested a pilot intervention to promote optimal gestational and infant weight with primigravid Hispanic women at a Federally Qualified Health Center (FQHC) on the U.S.-Mexico border. The intervention included promotora-led exercise, nutrition, breastfeeding activities (n = 23), supported by text/social media messaging (text messaging prenatally, private Facebook page postnatally). Measures included demographics, BMI, weight gain/retention, infant feeding, and attendance. Results Most women were U.S. born (73%), Spanish-language dominant (83%), with ≤ high school education (65%), and overweight/obese (56%). Retention rates were modest for the prenatal component (50%), supported by an SMS text-messaging program. Retention of the remaining postnatal sample, supported by a private Facebook® page, was 100%. Of women who regularly attended group sessions pre and postpartum, over 70% were within 5 lbs of pre-pregnancy weight at 6 months postpartum. A private Facebook® group was feasible for out-of-class support, including among women with regular cross-border mobility. Discussion While the intervention was well-received, almost 2/3 of the original participants did not follow up postpartum. Importantly, the findings indicate the use of social media (private Facebook® page) was more feasible than the SMS text-messaging program and may be a successful approach to reach and engage women living in mobile and transnational settings. Future studies should examine social media as an intervention tool to influence optimal weight and encourage healthy behaviors in primigravidas living near the U.S.-Mexico border.

Positive Impact of Integrative Medicine Approaches on Diabetes Related Care

Patients with diabetes have higher prevalence of depression and diabetes-related distress that negatively impacts care. Mindfulness-based approaches have shown to improve depression, diabetes-related distress, and in small studies also improve glycemic outcomes. We created a 90-minute, shared medical appointment; led by an endocrinologist, teaching patients integrative approaches to manage diabetes- related distress. We included patients with type 2 diabetes referred by a primary care provider or an endocrinologist, and assessed Diabetes Distress Scale (DDS), Patient Health Questionnaire-9 (PHQ-9) as well as Hemoglobin A1C (HbA1C), weight, blood pressure (BP), heart rate (HR) before the group visit. Thirty-four patients attended group sessions, with mean age of 63.9 years, mean baseline HbA1C 7.7% and mean BMI 33.3. The mean DDS was 36.2, and mean PHQ-9 was 7.8. Twenty-four patients followed up in clinic 3 months after initial appointment and showed mean reduction in HbA1C by 0.18% (p=0.35). Subgroup analysis of patients with baseline HbA1C ≥ 7.5% (n=11) showed mean reduction in HbA1C by 0.8% (p=0.005). No statistically significant changes in BP, HR or weight were seen, while a subgroup of patients with baseline A1C ≥7.5% had non-statistically significant mean weight loss of 1.3kg. This retrospective study of a mindfulness-based approach suggests positive clinical impact and need for a larger, randomized trial. Table 1. Baseline characteristics, change in parameters 3 months after interventionBaseline characteristicsTotal patients who attended (N=34)Patients with 3 months follow up (n=24)Subgroup with baseline HbA1C ≥7.5 (n=11)Mean age in years (SD)63.9 (10.2)65.2 (9.7)64.6 (10.9)% Women67.60%66.70%72.70%Mean body weight, kg (SD)94.3 (22.8)90.2 (16.6)91.7 (17.5)Mean BMI (SD)33.3 (7.2)31.9 (5.54)31.8 (6.0)Mean HgbA1C, % (SD)7.7 (1.3)7.5 (1.2)8.5 (0.9)Mean DDS (SD)36.2 (13.7)35.7 (14.3)35.9 (15.8)Mean PHQ-9 (SD)7.8 (5.2)7.4 (5.8)7.1 (6.7)Change in HbA1C from baseline to 3 months- 0.15 % (p=0.35)- 0.8 % (p=0.005)Change in weight from baseline to 3 months- 0.4 kg (p=0.48)- 1.3kg (p=0.17) Disclosure J. Ku: None. M. Freeby: None. R.S. Mullur: None.

Racial Differences in Weight Loss Mediated by Engagement and Behavior Change.

We set out to determine if a primarily Internet-delivered behavioral weight loss intervention produced differential weight loss in African American and non-Hispanic White women, and to identify possible mediators. Data for this analysis were from a randomized controlled trial, collected at baseline and 4-months. The intervention included monthly face-to-face group sessions and an Internet component that participants were recommended to use at least once weekly. We included overweight or obese African American and non-Hispanic White women (n=170), with at least weekly Internet access, who were able to attend group sessions. Monthly face-to-face group sessions were delivered in large or small groups. The Internet component included automated tailored feedback, self-monitoring tools, written lessons, video resources, problem solving, exercise action planning tools, and social support through message boards. Multiple linear regression was used to evaluate race group differences in weight change. Non-Hispanic White women lost more weight than African American women (-5.03% vs.-2.39%, P=.0002). Greater website log-ins and higher change in Eating Behavior Inventory score in non-Hispanic White women partially mediated the race-weight loss relationship. The weight loss disparity may be addressed through improved website engagement and adoption of weight control behaviors.

Providing Optimal Care for Every Patient in Group Cardiac Rehabilitation

Purpose: Cardiac rehabilitation supports patients recovering from acute coronary syndrome. Group programs provide a sense of community and can cater appropriately for large populations. However, meeting the needs of individuals attending group sessions is challenging, and patients may leave such programs with unmet needs and high levels of anxiety or depression.

Parent Engagement in Online Mindfulness Exercises Within a Parent Training Program for Post-Deployed Military Families.

Mindfulness has drawn increased attention in prevention programs targeting parents. Commonly, mindfulness-based programs are provided to reduce parental stress and improve child outcomes. Less often, researchers incorporate a mindfulness-informed approach, integrating a low dose of mindfulness exercises into an existing evidence-based parent training model. Little is known about participant engagement with mindfulness exercises in such programs. This non-experimental study focuses on families who are at risk for impaired parenting due to the unique stressor of a parent's deployment to war. The goal is to examine military parents' online engagement in mindfulness exercises and associations between engagement and dispositional mindfulness within a web-enhanced parent training program. Online tracking records and self-reported data were obtained from 370 military parents (207 families) who were assigned to the program; at 6-month follow-up, 68.6% of these parents were retained (at least one parent reported from 75.4% of families). Results showed that nearly half (44.6%) of the parents engaged with the exercises. Participants who attended face-to-face group sessions (i.e., attendees) engaged throughout the intervention period whereas participants who never attended group sessions (i.e., non-attendees) mostly engaged during the first month in the program. Attendees and mothers engaged more than non-attendees and fathers. While engaged parents self-reported increased dispositional mindfulness at 6-month follow-up compared to baseline, only mothers' engagement accounted for a significant proportion of the variance (3%) in dispositional mindfulness at 6-month follow-up, after controlling for covariates. Implications for incorporating online mindfulness exercises into parent training are discussed in the context of programming for military families.

Abstract MP004: Feasibility of an Appetite Awareness Intervention to Reduce Cardiovascular Disease Risk Factors and Binge Eating in African-American Women with Obesity

Background: Currently, 82.1% of African-American (AA) women are overweight or obese, and 48.9% of AA women have cardiovascular disease (CVD), the leading cause of death. Binge eating disorder (BED) is associated with severe obesity, psychiatric morbidity, and increased risk for CVD. Among AA women, BED is the most common eating disorder and has a 33% prevalence among those seeking weight loss. Since many adults with BED report becoming overweight after binge eating on a regular basis, intervening with individuals at risk to develop BED may be a viable strategy to prevent CVD and further weight gain. Purpose: To investigate the feasibility of an 8-week, community-based Appetite Awareness Training intervention among AA women who are overweight and obese reporting monthly binge eating episodes, and examine preliminary changes in CVD risk, eating self-efficacy, and binge eating between the intervention and control group. Methods: Eligible individuals were randomized to Appetite Awareness Treatment (AAT, n=16) or Wait-List Control (WLC, n=15) with the WLC receiving the AAT after 8-weeks of observation. The goal of Appetite Awareness Treatment is to help participants relearn their biological signals of hunger and satiety. Participants attend group sessions, and receive weekly homework to self-monitor their appetite cues. Assessments were conducted at 0 and 8 weeks at a community-based site. Linear mixed modeling was used to examine the baseline to 8-week changes between AAT and WLC groups on CVD risk factors (body weight, waist circumference, blood pressure) self-efficacy by Weight Efficacy Lifestyle Questionnaire (WEL), and binge eating by the Binge Eating Scale (BES). Results: The sample (N=31), had a mean age of 48.8 (SD±12.8), and a BMI of 33.7 kg/m 2 (SD±3.90). Retention was 87.5%, session attendance 65.9%, and homework completion 55%. There were significant group differences over time in the WEL score (p&lt;.01, d=1.06), and the BES score (p&lt;.001, d=.52) at the end of the intervention. The AAT group had an increase in the WEL score (+25.14±6.67), with no changes in the WLC group (-1.27±4.15). Additionally, the AAT group had a decrease in the BES score (-5.87±0.61), with no changes in the WLC group (0 ±0.01). There were no significant differences within and between groups in CVD risk factors. Conclusions: Our pilot trial results suggest that AAT is feasible in this population, with good retention, attendance, and preliminary evidence of a positive impact on eating self-efficacy, binge eating behaviors, and weight gain prevention. Future research should investigate the effectiveness of AAT to reduce binge eating and CVD risk in a larger sample and study with a longer duration.

Feasibility of a Friendship Network-Based Pediatric Obesity Intervention.

There is growing evidence supporting social network-based interventions for adolescents with obesity. This study's aim was to determine the feasibility of a social network-based intervention by assessing adolescents' friendship networks, willingness to involve friends in treatment, and how these factors influence enjoyment. Adolescents (N = 42) were recruited from a tertiary care obesity clinic. Participants gave a list of closest friends, friendship characteristics, and which of their friends they would involve in treatment. A subset (N = 14) participated in group treatment, were encouraged to bring friends, and invited to a second interview. Participants nominated a mean of 4.0 (standard deviation [SD] = 1.6) friends and were more likely to nominate closer friends (p = 0.003). Friends who attended group sessions were more likely to have multiple friendships in common with the participant's own network (p = 0.04). Involving friends in treatment is feasible and desired by adolescents and may be a novel approach for augmenting obesity treatment outcomes.