Audiotaped Sessions Research Articles

"I can't escape my scars, even if I do get better": A qualitative exploration of how adolescents talk about their self-harm and self-harm scars during cognitive behavioural therapy for depression.

Emerging evidence indicates that perceptions of self-harm behaviours and self-harm scars may thwart recovery from depression, yet limited research has explored adolescent accounts of their self-harm and scars during therapy. This study sought to explore how adolescents describe their self-harm behaviours and scars during Cognitive Behavioural Therapy (CBT) and explore the sociocultural discourses that may influence these descriptions. The participants were six female adolescents (aged 14-17years old) with clinical depression, who were engaging in self-harm. All participants accessed CBT as part of clinical trial evaluating three psychological treatments for major depressive disorder in Child and Adolescent Mental Health Services. Audio-taped CBT sessions were analyzed using discourse analysis. Within CBT sessions, adolescents drew upon stigma discourses in talking about their self-harm. Adolescent also described their self-harm scars as shameful and stigmatizing, and as "proof" of the legitimacy of their depression. It is important for CBT practitioners to understand the context of sociocultural discourses around self-harm behaviours and self-harm scars, which are reflected in how adolescents with depression describe these within therapy and may serve to maintain distress. The study indicates that awareness of use of language and intersecting sociocultural discourses can inform CBT practice.

Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion.

Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.

Rosalind Dymond Cartwright (1922-2021).

Memorializes Rosalind Dymond Cartwright (1922-2021). She was a pioneer in the fields of empathy and psychotherapy research and one of the first women to make significant contributions to the science of sleep and dreams and the field of sleep medicine. Upon receiving her PhD in 1949, she took a position at Mount Holyoke College. After 2 years, she moved to the University of Chicago where Carl Rogers hired her to oversee the many studies of audiotaped psychotherapy sessions that he was conducting to test the effectiveness of client-centered therapy. In 1954, she and Rogers coedited the landmark book, Psychotherapy and Personality Change. She also held positions at the University of Illinois College of Medicine, University of Chicago, and Rush University Medical Center. From 1971 to 1993 she was a grant reviewer for the National Institute of Mental Health, a role that allowed her to advocate anonymously for the support of research and training programs that greatly influenced the course of sleep research in the United States. Beginning in 1990, Roz served pro bono as an expert witness for the defense in several murder cases that involved a defense of sleepwalking, a non-REM parasomnia. At age 90 she immersed herself in the technology of spectral analysis scoring of polysomnogram data to argue that recent laboratory-based discoveries about sleepwalkers could be used to determine whether an alleged crime might have been committed during an arousal from sleep in which consciousness was impaired. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Motivational interviewing: Key ingredients associated with taking a step toward employment.

Objective: This study sought to identify key ingredients of motivational interviewing (MI) associated with taking a step in the direction of competitive employment (CE) for unemployed veterans with serious mental illness (SMI). Method: Data were analyzed from 195 audiotaped MI sessions targeted to employment conducted with 39 veterans with SMI. Sessions were coded and analyzed to identify components of MI practice predictive of taking any step in the direction of CE (e.g., asking for a referral to supported employment or conducting a job search). Predictor variables were (a) counselor MI talk behaviors and adherence to MI technical and relational principles and (b) client intensity and frequency of change talk and sustain talk. Covariates were age, gender, race, duration of unemployment, receipt of disability income, health status, work importance, work confidence, mental health diagnosis, and session number. Generalized estimating equations were used to create multivariate models. Results: After controlling for session number, work importance, work confidence and duration of unemployment, variables significant in the adjusted multivariate model were intensity of client change talk and sustain talk and counselor adherence to MI technical principles of cultivating change talk and softening sustain talk. Conclusions and Implications for Practice: Findings suggest that change talk and sustain talk during counseling sessions are associated with taking a step toward employment and that counseling focused on cultivating change talk and softening sustain talk increases the likelihood that unemployed veterans with SMI will take steps toward becoming competitively employed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Measuring cancer care experiences of Aboriginal and Torres Strait Islander people in Australia: Trial of a new approach that privileges patient voices

This study examined a new method for measuring the care experiences of Aboriginal and Torres Strait Islander people with cancer: the Indigenous People’s Experiences of Cancer Care Survey (IPECCS). The study assessed IPECCS’s: 1) performance; 2) ability to elicit information useful for service improvements; and 3) implementation potential. Three participant groups were recruited from five Australian cancer treatment sites: 1) Aboriginal and Torres Strait Islander people with cancer (+/- support person); 2) interviewers; and 3) health services staff. Trained interviewers administered IPECCS to participants with cancer in audiotaped sessions. Paper forms and transcripts were compared to assess performance, and problems/potential solutions reported by participants with cancer were assessed for actionability. All participant groups completed separate interviews regarding IPECCS. Selected implementation measures were assessed based on interviews and IPECCS administration. Participants (n=31) included 11 Aboriginal people with cancer, 7 support people, 4 interviewers, and 9 health staff. Aboriginal people with cancer spoke at length about their cancer care experiences and identified problems and potential solutions that could be acted upon by health services. Although some parts of the IPECCS form were well-completed, recording was inconsistent and inadequate. Aboriginal people with cancer and interviewers predominantly supported the IPECCS process; while most health staff supported the aims, they questioned its feasibility. Capturing domains of patient experience relevant to Aboriginal and Torres Strait Islander people requires a culturally safe, strengths-based approach. The tension between facilitating meaningful patient engagement and maximizing the efficiency of data collection and use must be resolved to realise the benefits of such an approach. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics.

Background:This study compared a computer and manual version of a tailored Coordinated Anxiety Learning and Management (VA CALM) protocol on provider fidelity to CBT and patient outcomes.Methods:This study was a cluster randomized controlled trial. Providers (N = 32) were randomized to deliver VA CALM by computer or manual. Veteran patients (N = 135), treated by study providers, were recruited. The primary outcome was CBT fidelity, measured by rating audiotaped sessions. Secondary outcomes were Veterans’ general (BSI-18 GSI, SF-12) and disorder-specific (GAD-7, PCL-5, PHQ-9) outcomes assessed at baseline, three and six month follow-up.Results:We found a large (d = 0.88) but not statistically significant difference in mean fidelity rating scores between conditions. Compared with the manual, participants with generalized anxiety disorder receiving VA CALM by computer reported lower GAD-7 scores at three (−5.88; 95% CI=−11.37, −0.39) and six month (−5.25; 95% CI=−10.29, −0.22) follow-ups (d = 0.37 to 0.55). Participants in the computer and manual conditions reported lower PHQ-9 (−3.11; 95% CI=−5.51, −0.71; −4.06; 95% CI=−7.22, −0.90, respectively) and BSI-18 GSI (0.78; 95% CI=0.68,0.90; 0.71; 95% CI=0.58, 0.87, respectively) scores from baseline to six month follow-up. We did not find statistically significant differences over time or between conditions on SF-12 or PCL-5 scores.Limitations:This study was underpowered to test the primary outcome. Small samples sizes in the disorder-specific subgroup analysis may limit the generalizability of findings.Conclusions:Neither modality proved to be superior on VA CALM fidelity. The computer version of VA CALM, compared to the manual, may provide modest benefit to Veterans with GAD.

Contextual Fit of a Family Evidence-Based Intervention for Preventing Youth Alcohol Use in Mexico.

Reducing youth alcohol use is a public health priority that can be addressed by implementing evidence-based preventive interventions (EBPIs) with high fidelity. However, when EBPIs are delivered in a new geographical setting, lack of contextual fit might interfere with expected effects. The purpose of our study was to understand the contextual fit of the family preventive program, Guiding Good Choices (GGC), to inform its future adaptation in Zacatecas, Mexico. Four focus groups were conducted with parents of children aged 9-14years (N = 43) from four private companies. After transcribing audiotaped sessions, we used a general inductive approach to obtain codes and derive themes. Parents expressed a high level of interest in program content, highlighting its potential to decrease underage drinking in Mexico. Surface-structure modifications of program audiovisual materials (e.g., new videos with Mexican actors and locations) and delivery methods were recommended by parents to maximize participant acceptability and engagement. Participant definitions of family and perception of family dynamics both support the cultural relevance of the program modules and activities related to this content. Underage drinking was acknowledged by parents as a major problem in Zacatecas. Our findings suggest a need for incorporating an extra session that focuses on addressing low alcohol literacy levels and parents' positive alcohol expectancies. Machismo was not considered a cultural factor that could affect attendance and program activities. In fact, we observed an opportunity to use local masculinity to ensure practice of parental skills at home. Due to the needs expressed by participants and the apparent compatibility and fit of the curriculum contents with the new context, we conclude that GGC could be an adequate EBPI for preventing underage drinking in Mexico.

Psychometric Properties of the Norwegian Version of the Cognitive Therapy Adherence and Competence Scale (CTACS) and Its Associations With Outcomes Following Treatment in IAPT Norway.

Background: No studies have examined the underlying structure or predictive validity of the Cognitive Therapy Adherence and Competence Scale (CTACS). Examining the structure of the CTACS is of great relevance because it could provide information on what constitutes competence in CBT, and whether some underlying factors are more important for predicting treatment outcomes than others. This study investigates the psychometric properties of the Norwegian version of CTACS and its associations with treatment outcomes in a sample of primary care clients who received CBT for anxiety and/or depression.Method: Independent assessors rated audiotaped therapy sessions (early, mid and late in treatment) in a sample of 132 primary care clients (mean [SD] age = 34.8 [11.8], 63.6% women), participating in the Prompt Mental Health Care trial. Outcomes were symptoms of anxiety and depression assessed by patient self-report questionnaires. Structural validity was examined by means of confirmatory and exploratory factor analyses (CFA/EFA), whereas longitudinal associations with treatment outcome were explored by adopting multilevel modeling.Results: No evidence was found for the divergent validity of the constructs competence and adherence as indicated by a very high correlation between these two subscales in CTACS (0.97). Regarding reliability, ICCs for the mean score of the full competence scale and its associated subscales were generally good to excellent (0.70–0.80), although the subscale measuring the quality of the therapeutic relationship was relatively low (0.44). Internal consistency was overall acceptable, but our CFA models did not provide an acceptable fit for the pre-specified one-factor and four-factor solutions. EFA results were difficult to interpret, with a sub-optimal three-factor solution providing best model fit and only two meaningful factors [CBT specific skills (α = 0.82) and session structure (α = 0.59)]. Overall, the results indicated no evidence for the scales' predictive validity.Conclusion: Our findings point to several psychometric problems of the CTACS that may limit both its research and clinical utility. The importance of providing empirical evidence for both reliability and validity aspects of scales are discussed and suggestions for future research are provided.

Seizure detection devices: Exploring caregivers’ needs and wishes

IntroductionUser preferences for seizure detection devices (SDDs) have been previously assessed using surveys and interviews, but these have not addressed the latent needs and wishes. Context mapping is an approach in which designers explore users’ dreams and fears to anticipate potential future experiences and optimize the product design. MethodsA generative group session was held using the context mapping approach. Two types of nocturnal SDD users were included: three professional caregivers at a residential care facility and two informal caregivers of children with refractory epilepsy and learning disabilities. Participants were invited to share their personal SDD experiences and briefed to make their needs and wishes explicit. The audiotaped session was transcribed and analyzed together with the collected material using inductive content analysis. The qualitative data was classified by coding the content, grouping codes into categories and themes, and combining those into general statements (abstraction). Results“Trust” emerged as the most important theme, entangling various emotional and practical factors that influence caregiver’s trust in a device. Caregivers expressed several factors that could help to gain their trust in an SDD, including integration of different modalities, insight on all parameters overnight, personal adjustment of the algorithm, recommendation by a neurologist, and a set-up period. Needs regarding alerting seemed to differ between the two types of caregivers in our study: professional caregivers preferred to be alerted only for potentially dangerous seizures, whereas informal caregivers emphasized the urge to be alerted for every event, thus indicating the need for personal adjustment of SDD settings. ConclusionIn this explorative study, we identified several key elements for nocturnal SDD implementation including the importance of gaining trust and the possibility to adjust SDD settings for different types of caregivers.

“I am not a statistic” ovarian cancer survivors’ views of factors that influenced their long-term survival

ObjectiveAlthough a high proportion of women with advanced stage ovarian cancer die within five years, approximately 30% will survive longer than this. The factors contributing to exceptional survival are currently poorly understood. The viewpoints of ovarian cancer survivors were qualitatively explored to determine the factors they felt have influenced their exceptional ovarian cancer survival. MethodsFour focus groups, one each in Los Angeles (California), Ann Arbor (Michigan), New York (New York) and Edmonton (Alberta, Canada), were conducted with women who had survived at least five years. Physical activity, diet, meditation, prayer, treatment, complementary medicine, and side effects were explored in semi-structured discussions. The audiotaped sessions were transcribed and coded and then analyzed using Dedoose Version 8.0.35, a qualitative analysis software. ResultsOf the 26 women who participated, 23 had advanced stage disease. Three overarching themes emerged: (a) survivors had improved their ‘lifestyles’, including but not limited to fitness and diet; (b) survivors were able to draw on strong support systems, which included family, friends, support groups, faith communities, and healthcare workers; and (c) survivors had a strong life purpose, which manifested as positivity, taking charge of their lives, and advocating for themselves. ConclusionsLong-term survivors have varying experiences with their cancer, but identified lifestyle modification, motivation and persistence, strong life purpose, and strong support systems as key elements in their better survival. These preliminary findings indicate the need for further prospective studies to determine whether meaningful differences exist between short term and long term survivors on these characteristics.

Exploring Treatment as Usual for Pediatric Anxiety Disorders Among School-Based Clinicians

Cognitive-behavioral therapy (CBT) remains the only evidenced-based psychosocial treatment for pediatric anxiety. Adoption of CBT in community settings has been slow, and data on CBT use in schools specifically are limited. This study examined: (1) school-based clinicians’ perceptions of their treatment approach for pediatric anxiety disorders, use of therapeutic strategies reported after each session, and overall perceived confidence in treating anxiety disorders, and (2) independent evaluator (IE) ratings of clinicians’ use of CBT, the frequency and quality of specific CBT elements in sessions, and overall competence in treating anxiety. An exploratory aim examined whether clinician characteristics were associated with IE-rated CBT use. Participants included 25 school-based clinicians who delivered treatment as usual in a randomized controlled trial of treatments for anxious children and adolescents. At baseline, clinicians reported their approach to treating anxious youth. After each session (N = 475), they reported the therapeutic strategies they used. IEs rated audiotaped therapy sessions (N = 90). Results indicated a majority of school clinicians reported using a behavioral or cognitive-behavioral approach for anxiety (68% at baseline and in 76% of sessions). In contrast, 14% of the IE-rated sessions had the primary therapeutic strategy coded as cognitive-behavioral. Clinician confidence and IE competence ratings were also discrepant, with clinicians rating themselves as somewhat confident in treating anxious youth but IEs assigning a low competence rating. Use and quality of CBT elements based on IE-rating were low. Several clinician characteristics were associated with CBT use. Findings suggest a need to improve the training of school-based clinicians in EBTs for students with anxiety.

Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions.

The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.

Hispanic Families' Action Plans for a Healthier Lifestyle for Diabetes Management.

Purpose The purpose of this study was to conduct focus groups with Hispanic patients with type 2 diabetes and their family members who participated in a culturally tailored, family-based diabetes intervention about their action plans for a healthier lifestyle. Methods Five separate focus groups were led in Spanish by an experienced bicultural/bilingual moderator. The audiotaped sessions occurred at the end of the 8-week diabetes educational program. Data were transcribed in Spanish and translated into English. Qualitative content analysis was used to analyze the findings. Results Eighty-four Hispanic adults participated with an equal representation of patients with diabetes and family members. Most persons were female (63.1%) and the majority of persons were born in Mexico. The mean (SD) age of participants was 44.2 (14.3) years. Six themes emerged from the data: healthier eating habits, increasing physical activity, taking care of my sugar, coping with emotions, for the family, and empowerment and increased self-efficacy. Conclusions Hispanics created action plans that promoted healthier lifestyle behaviors individually and as a family. This type of behavior change may result in better diabetes management and fewer complications. Research studies are needed to assess the sustainability of action plans and their impact on glycemic control and diabetes risk factors. Additional studies are needed to address emotional eating and mental health factors.

Therapist adherence and therapeutic alliance in individual cognitive-behavioural therapy for adolescent binge-eating disorder.

To evaluate psychological treatments for adolescent binge-eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive-behavioural therapy (CBT) for adolescents with BED. In a randomised-controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio-taped CBT sessions from a sample of N=64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between-patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.

Clients and case managers as neoliberal subjects? Shaping session tasks and everyday interactions with severely mentally ill (SMI) clients

ABSTRACTThis article explores how multiple contexts – professional knowledge (e.g. case management), institutional practices (e.g. New Public Management), and mental health policies and legislations (e.g. Mental Health Act) – under neoliberal governance (re)produce ways social workers interact with their clients in moment-to-moment interactions. It is part of a larger process and outcome research project on cross-cultural social work practice in outpatient community mental health settings in an urban Canadian city. Using transcripts of audio-taped sessions between social workers and clients with severe mental illness, and inspired by critical theories of language, knowledge and power, we illustrate how neoliberal themes (re)position clients and social workers in negotiating session tasks in everyday interactions, and how these interactions shape the clients and social workers as desirable and undesirable neoliberal subjects. These detailed studies in micro-interactions can be used as practice examples in considering how social workers can be critically reflective of our own micro practice and resist the governing neoliberal ideology in the macro level.

Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents.

We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas' core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.

Client predictors of the therapeutic alliance in individual resiliency training for first episode psychosis

Individuals experiencing their first episode of psychosis (FEP) are often reluctant to seek treatment, and are difficult to engage and retain in mental health services. The therapeutic alliance (TA), or the affective and collaborative bond between therapist and client, is predictive of better treatment outcomes for clients with FEP; thus, it is important to understand the predictors of the TA in order to determine how best to foster a positive alliance with these individuals. The primary aim of the present study was to examine whether baseline client characteristics, including severity of symptoms, social functioning, and insight, were associated with the TA. The exploratory aim was to examine associations between demographic variables (age, race, and gender) and the TA. The present study included a subsample of participants (n = 134) who received Individual Resiliency Training (IRT) as part of the NAVIGATE treatment in the Recovery After An Initial Schizophrenia Episode Early Treatment Program study. Four trained research assistants rated the TA from early audiotaped sessions of IRT. Multilevel modeling was utilized given the nested data structure. Results indicated that more severe positive and less severe negative symptoms were significantly and uniquely associated with a better therapeutic alliance, as was female gender. The findings suggest that client symptom profiles should be considered when developing a TA with FEP clients.

The Flexible Lifestyles Empowering Change (FLEX) Intervention Trial for Adolescents with Type 1 Diabetes—Primary and Secondary Outcomes

Youth with T1D often have poor glycemic control and compromised health and well-being. Our aim was to test the efficacy of the FLEX adaptive behavioral intervention on the primary (HbA1c) and secondary (psychosocial and metabolic) outcomes at 18 months. Youth (n=258) aged 13-16 years, diagnosed >1 year with T1D with HbA1c from 8.0-13.0%, were randomized at two sites to FLEX or usual care control. Mean (sd) duration of diabetes was 6.4 (3.8) years, 50% were girls, 78% non-Hispanic white, mean HbA1c was 9.6% (1.2) and 71% used insulin pump therapy. FLEX used motivational interviewing and problem-solving skills training to enhance self-management. Intervention fidelity was assessed via random selection of audiotaped sessions for counseling strategy and session content. Intent-to-treat analyses used mixed effects models, with fixed effects of site, timepoint, intervention group, intervention by timepoint and baseline level of primary or secondary outcomes, with a random intercept (alpha=0.05). Retention was 97%, with intervention fidelity 4.6 out of 5 for counseling strategy and 97.4% complete for session content. HbA1c was not statistically significantly different between intervention and control at 18 months. Among secondary outcomes at 18 months, the intervention was associated with improved scores for symptoms of depression (p=0.04), quality of life (p=0.01), motivation (p=0.009), problem-solving (p=0.04), and diabetes self-management profile (p=0.01), as well as better total cholesterol (p=0.04), and better diastolic blood pressure (p=0.01). The FLEX intervention did not change the primary outcome, but did positively effect psychosocial outcomes over the 18 months of the trial. Further analyses will reveal information regarding drivers of positive response to the intervention and will point to directions for improvement in the approach, perhaps incorporating more specific direction towards achievement of glycemic targets. Disclosure E.J. Mayer-Davis: None. F.K. Bishop: None. K.A. Driscoll: None. C.M. Hunter: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. M. Seid: None. D. Standiford: None. J. Thomas: None.

2067 Developing a cultural adaptation of a telephone genetic counseling intervention for Latina women at-risk of hereditary breast and ovarian cancer

OBJECTIVES/SPECIFIC AIMS: The overall goal of this project is to enhance the use of GCRA in Latina breast cancer survivors at high risk of hereditary breast and ovarian cancer to reduce disparities in GCRA uptake. The aims of the study are to (1) develop a cultural adaptation of an evidence-based TGC intervention that consists of phone genetic counseling and a booklet, (2) evaluate the impact of TGC Versus Usual Care, and (3) explore the communication patterns in TGC and genetic counseling sessions with an interpreter. METHODS/STUDY POPULATION: We are conducting a 2-phase, mixed methods study. In Phase I we will develop a cultural adaption of an evidence-based intervention (TGC) for high-risk Latina breast cancer survivors using the Learner Verification and Revision Framework (n=15). In Phase II we will use a cluster randomized design with four community sites randomized to Spanish TGC (n=2 sites) or usual care (n=2 sites) (n=60; 15 per site). The primary outcome is genetic counseling uptake. Among women who receive genetic counseling either through TGC (n~30) or with an interpreter (n~15), we will assess counseling quality by reviewing 20 randomly selected audiotaped sessions (10 TGC; 10 interpreters). We will evaluate women’s HBOC knowledge and satisfaction with counseling. Communication processes and outcomes will be assessed using gold standard RIAS quantitative coding system and qualitative discourse analysis. RESULTS/ANTICIPATED RESULTS: We elicited input from transdisciplinary team members to develop an initial adaptation of a TGC print booklet and intervention protocol for use with high-risk Latina breast cancer survivors with limited English proficiency. The booklet contains low-literacy information about HBOC, risk factors, pros and cons of testing, and management strategies. Based on these materials and prior work, we anticipate TGC will consist of one 1 hour or less TGC session by phone. Participants interested in pursuing testing will receive a saliva kit and will participate in a second TGC session (30 min) to discuss test results and management options. DISCUSSION/SIGNIFICANCE OF IMPACT: Given access barriers and the shortage of Spanish-speaking genetic counselors, adapting and translating TGC intervention is a promising strategy that could reduce disparities by broadening the reach and accessibility to genetic counseling while enhancing the quality of the service for Latinas with limited English proficiency.

Quality of motivational interviewing matters: the effect on participation in health-promotion activities in a cluster randomized controlled trial.

Objectives This study aims to evaluate the effectiveness of a "blended" workplace health-promotion intervention, alongside identification of key components beneficial for future implementation strategies. Methods Within a cluster randomized controlled trial, 491 employees at increased risk of cardiovascular disease were allocated to the limited (N=217; 9 clusters) or extensive (N=274; 8 clusters) intervention. The extensive intervention consisted of motivational interviewing (MI) within the framework of a web-based health risk assessment (HRA), a blended care approach. The limited intervention received solely the web-based HRA. Occupational health physicians (N=21) within three organizations delivered the intervention. Implementation components investigated included: HRA (reach and participation), newsletters (percentage read), and MI sessions (number and quality). MI quality was determined by scoring audiotaped MI sessions, using the MI treatment integrity code. After 6 and 12 months, effects on participation in health-promotion activities and its associations with components of implementation were determined by mixed-effects models. Results Over 80% of employees participated in health-promotion activities, with an additional 8% in the extensive compared to the limited group. In the extensive intervention, those with more or better quality MI sessions were more likely to participate in health-promotion activities. Increased MI quality was associated with sustained participation. Conclusions This study suggests that participation in health-promotion activities can be increased by adding MI to a web-based approach and improving the quality of the MI delivered. Interventions with MI should include optimized delivery and quality of MI sessions.