Baseline Motivation Research Articles

Baseline Health of University Workers Pre-Intervention in Lifestyle: HaSEN

Objective: The aim of the present study was to analyse and compare the initial health situation before starting the lifestyle programme in 4 editions of the programme. Theoretical framework: HaSEN is an annual intervention programme for the generation of healthy habits on eating behaviour (psychonutrition) and active lifestyle (physical exercise) in university workers in the contemplative phase of motivation to change. Methods: A total of 74 workers participated between the 2019, 2020, 2021 and 2022 editions from a Spanish university (24-59 years; M = 42.3; SD = 8.5) 19 men (26%) and 55 women (74%). Anthropometric, biological, lifestyle and psychological variables were analysed. Results and Discussion: Anthropometric, biological, lifestyle and psychological variables were analysed. Adherence to the Mediterranean diet in the 2021 edition workers at the start of the intervention was found to be higher than in 2019 and achievement motivation higher than in 2020, results that could be related to the special situation derived from the Covid-19 pandemic. Implications of the research: This shows the importance of knowing the baseline health status of workers in behaviours such as those observed in the last edition (2022) in terms of worsening adherence to the Mediterranean diet. This aspect highlights the need to apply interventions such as the HaSEN programme for the maintenance of a healthy lifestyle in terms of nutrition and physical exercise behaviour in the population under study. Originality/value: This study contributes to the scientific literature on public health in the population of university workers. It provides retrospective and prospective information on baseline health status and motivation to change habits to maintain a lifestyle in a working population subjected to high levels of work demands and the implications that this may have on the overall health status of this population.

Patient motivation as a predictor of digital health intervention effects: A meta-epidemiological study of cancer trials.

The objective of this meta-epidemiological study was to develop a rating that captures participants' motivation at the study level in digital health intervention (DHI) randomised controlled trials (RCTs). The rating was used to investigate whether participants' motivation is associated with the effect estimates in DHI RCTs for cancer patients. The development of the rating was based on a bottom-up approach involving the collection of information that captures participants' baseline motivation in empirical studies from the Smartphone-RCCT Database. We specified three indicators for rating: indicator 1 captures whether the study team actively selects or enhances the motivation of the potential study participants; indicator 2 captures the study participants' active engagement before the treatment allocation; and indicator 3 captures the potential bond and trust between the study participants and the person/institution referring to the study. The rating of each indicator and the overall rating varies between high motivation, moderate motivation, and low motivation. We applied the rating across 27 DHI RCTs with cancer patients. We performed meta-regression analysis to examine the effect of patient motivation on quality of life (QoL), psychological outcomes, and attrition. The intraclass correlation coefficient (ICC) indicated moderate to poor inter-rater reliability. The meta-regression showed that cancer patients' overall motivation before engaging in the intervention was associated with the treatment effect of QoL. Patient motivation was not found to be associated with psychological outcomes or attrition. Subgroup analyses revealed that the clinical effects of DHIs were more prevalent in the high-motivation subgroups, whereas the low-motivation subgroups were unlikely to show intervention benefits. The likelihood of dropouts from DHIs seems to be especially high among the low-bond (indicator 3) subgroup. We suggest using single indicators since they reflect specific content. Better reporting about baseline motivation is required to enable meaningful interpretations in not only primary studies but also in evidence syntheses.

Do improvements in motivational language predict alcohol use in motivational interviewing? Ambivalence matters.

Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most useful for clients with ambivalence about change and less valuable for those who are ready to implement new behaviors or are opposed to change. To address this hypothesis and potentially add precision to MI delivery in clinical settings, we tested whether the relationship between clients' in-session motivational language and posttreatment alcohol use depended on their baseline motivation to change. Client speech from 149 sessions from Project MATCH were analyzed. A cluster analysis of the percent change talk during the first decile of the session identified three motivational groups: opposed, ambivalent, and ready. The change in percent change talk (C-PCT) across the session was calculated for each group. Zero-inflated negative binomial analysis was used to test whether the effect of C-PCT on end-of-treatment drinking varied between motivational groups. The count part of the model revealed a significant interaction between C-PCT and membership in the ambivalent group (b = -17.710, 95% CI [-25.775, -9.645], p < .001), only for those who received MI. Favorable C-PCT was associated with less drinking (b = -15.735, p = .004). Only baseline drinking was a significant predictor of abstinence at follow-up (b = .032, 95% CI [0.012, 0.051], p = .001). A putative MI mechanism-improved client motivational language-appears most important for clients who express ambivalence in the opening minutes of the session, with minimal value for those who do not. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effectiveness of Text Support for Stopping Smoking in Pregnancy (MiQuit): Multi-Trial Pooled Analysis Investigating Effect Moderators and Mechanisms of Action.

Digital cessation support appeals to pregnant smokers. In two pooled RCTs, MiQuit, a pregnancy-specific tailored text messaging intervention, did not show effectiveness for validated prolonged abstinence. However, secondary outcomes and potential moderators and mediators have not been investigated. We aimed to determine, using pooled RCT data: (1) MiQuit effectiveness on a range of smoking outcomes; (2) whether baseline tobacco dependence or quit motivation moderate effectiveness; (3) whether hypothesized mechanisms of action (quitting determination, self-efficacy, baby harm beliefs, lapse prevention strategies) mediate effectiveness. Pooled data analysis from two procedurally identical RCTs comparing MiQuit (N = 704) to usual care (N = 705). Participants were smokers, <25 weeks pregnant, recruited from 40 English antenatal clinics. Outcomes included self-reported 7-day abstinence at 4 weeks post-baseline and late pregnancy, and prolonged abstinence. Late pregnancy outcomes were also biochemically validated. We used hierarchical regression and structural equation modeling. MiQuit increased self-reported, 7-day abstinence at 4 weeks (OR = 1.73 [95% CI 1.10-2.74]) and was borderline significant at late pregnancy (OR = 1.34 [0.99-1.82]) but not for prolonged or validated outcomes. Effectiveness was not moderated by baseline dependence (heaviness of smoking "low" vs. "moderate-high") or motivation (planning to quit ≤30 days [high] vs. >30 days [low]), but effects on self-reported outcomes were larger for the high motivation sub-group. MiQuit had a small effect on mean lapse prevention strategies (MiQuit 8.6 [SE 0.17], UC 8.1 [SE 0.17]; P = .030) but not other mechanisms. MiQuit increased short-term but not prolonged or validated abstinence and may be most effective for those motivated to quit sooner. Digital cessation support appeals to pregnant smokers. MiQuit, a tailored, theory-guided text messaging program for quitting smoking in pregnancy, has not shown effectiveness for validated prolonged abstinence in two previous RCTs but its impact on other smoking outcomes and potential mechanisms of action are unknown. When pooling trial data, MiQuit increased self-reported short-term abstinence, including making a quit attempt and abstinence at 4-week follow-up, but not late pregnancy, sustained, or validated abstinence. MiQuit appeared effective at late pregnancy for participants with high quitting motivation, but its mechanisms of action remain uncertain. Additional support components are likely required to enhance effectiveness.

Does motivation for practising mindfulness moderate the effects of mindfulness training on stressed adults?

AbstractBackgroundMindfulness‐based intervention (MBI) has been associated with positive health outcomes in adults; however, there are important gaps in our knowledge of factors that influence which individuals are more likely to engage with and benefit from these interventions. Research on other types of behavioural interventions suggests that motivation changes over the course of intervention and may moderate attendance and therapeutic outcomes. This study investigated changes in motivation for practising mindfulness across an MBI and associations between baseline motivation and outcomes, to gain a preliminary understanding of the role of motivation in MBI adherence and outcomes.MethodsIn a sample of adults (N = 80) who received an MBI, we characterised change in motivation from pre‐ to postintervention and tested whether baseline motivation predicted change in attendance and outcomes.ResultsWe found that some, but not all, dimensions of motivation for practising mindfulness increased and also were associated with attendance and pre–post change stress and emotion regulation.ConclusionsOur findings suggest that there may be potential for optimising MBI through attention to individual differences in motivation and change in motivation over time. The findings justify research with larger sample sizes, control groups and repeated measurements to test the temporal ordering of changes in these outcomes.

The promise of using study-together groups to promote engagement and performance in online courses: Experimental evidence on academic and non-cognitive outcomes

Researchers and practitioners of online education have consistently emphasized the importance of facilitating peer interaction and mutual support to create a sense of community, which in turn may enhance motivation, promote extrinsic accountability, and improve learning outcomes. Despite these assertions, experimental evidence on the effects of peer support in college online courses is limited. To address this gap, we conducted a randomized controlled trial to examine the impact of a study-together group intervention on students' academic and non-cognitive outcomes in a for-credit online course at a public four-year college. Our findings indicate that students who were offered a study-together group reported a higher sense of belonging than those who were not. Additionally, students with lower academic preparation and lower baseline motivation demonstrated improved academic performance as a result of this intervention, while students who preferred passive interaction reported increased motivation. However, for students with higher baseline motivation and those who preferred active interaction, the intervention appeared to negatively influence their time management.

Factors affecting the effectiveness of the physical activity counselling intervention implemented in primary health care in adults with type 2 diabetes

BackgroundType 2 diabetes (T2D) has become a major public health threat; physical inactivity and obesity are both independent risk factors. Increasing daily physical activity (PA) significantly benefits treatment. Individual PA counselling is helpful for people with T2D, especially those with previous inactivity or with diabetes complications. This study evaluated factors contributing to effectiveness of PA counselling in primary health care (PHC) patients with T2D in a real-world setting and using data elicited from electronic health records (EHRs).MethodsAll patients with T2D were offered the opportunity to participate in a PA program organized as part of basic PHC services in the Siun sote region in North Karelia, Finland, from October 2016 to December 2018. The study population consists of patients aged 19 to 87 years (n = 546). During the intervention information on possible other factors in addition to age and sex influencing the intervention effect such as amount of counselling sessions, changes in PA and patients´ motivation was gathered. Changes in the participants’ PA activity was generated by following the predefined rules from patient records and by assessing the descriptive documentation of activity patterns. The patients’ motivation level was assessed using a Likert scale.ResultsOver 60% of participants who attended PA counselling more than three times increased their PA compared with 1% of participants with one counselling session. Of the whole intervention group, the participants experiencing the largest weight loss were those with an increased level of PA (-1.36 kg vs. -0.63 kg among those with no change in PA). Age, sex, and baseline motivation did not affect the change the PA nor the main intervention outcomes.ConclusionsPatients’ compliance with the intervention was reflected in the number of PA counselling sessions attended which in turn was seen as increased levels of PA as well as better treatment outcomes. In the implementation of lifestyle counselling interventions attention should be paid on sufficient amount and frequency of counselling sessions. The individually tailored PA counselling provided in PHC has similar effects regardless of sex and age.

ABC-training as a new intervention for hazardous alcohol drinking: Two proof-of-principle randomized pilot studies.

ABC-training is a new intervention to encourage health behavior change that targets the automatic activation of adaptive beliefs (i.e. automatic inferences). The aim of this proof-of-principle study was to test the effectiveness of web-based ABC-training to change outcome expectancies of alcohol drinking in a sample of hazardous drinkers. One exploratory and one confirmatory experiment with two between-subject conditions (online ABC- and control-training) and assessments at baseline and 1 week later (after three sessions of training). Participants recruited on Prolific Academic completed the web-based study. Adults with self-reported hazardous alcohol drinking (Experiment 1: 193 adults, United Kingdom, age mean = 46.7 years; Experiment 2: 282 adults, different nationalities, age mean = 38.3 years). ABC-training involved completing an online task that required choosing personally relevant alternative behaviors to drinking alcohol in personally relevant antecedent contexts to attain personally important outcomes. Comparator was control-training, in which participants selected both the alternative behaviors and alcohol drinking an equal number of times. Training was completed at baseline, after 3 days and after 1 week. Primary outcome was change in automatic and self-reported (negative/positive) outcome expectancies of alcohol drinking from baseline to after 1 week. Secondary outcomes were change in weekly alcohol consumption, self-efficacy, craving and motivation (and approach-alcohol associations in Experiment 1). Moderators were baseline outcome scores, motivation, age and alcohol dependency. Findings of this study are as follows: stronger increase in negative outcome expectancies after ABC- than control-training (Experiment 1: self-report, 95% confidence interval of difference scores (CIdiff ) = [0.04, Inf]; automatic, CIdiff = [0.01, Inf]; Experiment 2: self-report, CIdiff = [0.16, Inf]; automatic, CIdiff = [0.002, Inf]). Stronger reduction in self-reported positive outcome expectancies after ABC- than control-training (Experiment 1: CIdiff = [-Inf, -0.01]; Experiment 2: CIdiff = [-Inf, -0.21]) but mixed findings on automatic positive outcome expectancies (Experiment 1: CIdiff = [-Inf, 0.02]; Experiment 2: CIdiff = [-Inf, -0.001]). ABC-training may change outcome expectancies of alcohol consumption, but testing of clinically relevant effects in other samples is warranted.

Do brief motivational interventions increase motivation for change in drinking among college students? A two-step meta-analysis of individual participant data.

Brief motivational interventions (BMIs) are one of the most effective individually focused alcohol intervention strategies for college students. Despite the central theoretical role of motivation for change in BMIs, it is unclear whether BMIs increase motivation to change drinking behavior. We conducted a two-step meta-analysis of individual participant data (IPD) to examine whether BMIs increase motivation for change. N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). We included 15 trials of BMI (N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually-delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). Different measures and responses used in the original trials were harmonized. Effect size estimates were derived from a model that adjusted for baseline motivation and demographic variables for each trial (step 1) and subsequently combined in a random-effects meta-analysis (step 2). The overall intervention effect of BMIs on motivation for change was not statistically significant (standard mean difference [SMD]: 0.026, 95% CI: [-0.001, 0.053], p = 0.06, k = 19 comparisons). Of the three subtypes of BMIs, GMI, which tended to provide motivation-targeted content, had a statistically significant intervention effect on motivation, compared with controls (SMD: 0.055, 95% CI: [0.007, 0.103], p = 0.025, k = 5). By contrast, there was no evidence that MI + PF (SMD = 0.04, 95% CI: [-0.02, 0.10], k = 6, p = 0.20) nor PF increased motivation (SMD = 0.005, 95% CI: [-0.028, 0.039], k = 8, p = 0.75), compared with controls. Post hoc meta-regression analysis suggested that motivation sharply decreased each month within the first 3 months postintervention (b = -0.050, z = -2.80, p = 0.005 for k = 14). Although BMIs provide motivational content and normative feedback and are assumed to motivate behavior change, the results do not wholly support the hypothesis that BMIs improve motivation for change. Changing motivation is difficult to assess during and following interventions, but it is still a theoretically important clinical endpoint. Further, the evidence cautiously suggests that changing motivation may be achievable, especially if motivation-targeted content components are provided.

Examining the influence of tobacco control mass media campaign expenditure on the association between motivation to stop smoking and quit attempts: A prospective study in England

ObjectiveTo explore whether expenditure on national tobacco control mass media campaigns moderates the association between motivation to stop smoking and future quit attempts. MethodData were from 2601 people who smoke participating in a population survey with 12-month follow-up between April 2015 and February 2021. We used logistic regression to test associations of (i) baseline level of motivation to stop smoking, (ii) mean monthly tobacco control mass media campaign expenditure in England between baseline and follow-up, and (iii) their interaction, on past-year quit attempts assessed at 12-month follow-up. Covariates included age, sex, occupational social grade, and region. ResultsBetween baseline and follow-up, 38.6% of participants made a quit attempt. Each one-point increase in baseline motivation to stop smoking was associated with 1.37 times greater odds (95%CI = 1.31–1.43) of making a quit attempt over 12-month follow-up. Each one standard deviation increase in tobacco control mass media expenditure between baseline and 12-month follow-up was associated with 13% greater odds of making a quit attempt (95%CI = 1.05–1.23). There was no significant interaction between mass media expenditure and motivation to stop on quit attempts (OR = 1.01, 95%CI = 0.97–1.05); the data provided strong evidence for the null (Bayes factors = 0.07 and 0.04 based on expected effect sizes of OR = 1.5 and OR = 0.67, respectively). ConclusionsAmong people who smoke, self-reported level of motivation to stop strongly predicted whether they made a quit attempt in the subsequent year. Increased expenditure on tobacco control mass media campaigns was associated with increased quit attempts. The association between motivation and quit attempts did not differ according to tobacco control mass media expenditure over this period.

Role of serotonin in modulation of decision-making in Parkinson's disease.

Dysfunction of dopaminergic pathways has been considered to play a pivotal role in Parkinson's disease (PD), affecting the processing of emotional and rewarding information, and potentially leading to symptoms of depression or apathy. However, some aspects of motivation in PD might be affected by non-dopaminergic mechanisms. The objective of this experimental medicine study was to investigate the contribution of serotonergic modulation via administration of citalopram (20 mg) for 7 days on motivated decision-making in twenty PD patients, measured using several different computerised tasks and clinical questionnaires that probe different aspects of decision-making. Twenty healthy controls were additionally tested without medication to assess any baseline differences between the two groups. Results indicated that PD patients were overall less motivated than controls on an effort- and reward-based decision-making task. Citalopram increased or decreased willingness to exert effort for reward, depending on whether baseline motivation was high or low, respectively. A task assessing decision-making under risk revealed higher levels of risk aversion for potential losses in PD patients, which neither serotonin nor the patient's regular dopaminergic medication seemed to restore. However, citalopram in PD was associated with more risk-seeking choices for gains, although patients and controls did not differ on this at baseline. The results provide evidence for a role of the serotonergic system in influencing some aspects of motivated decision-making in PD processes.

A CONVERSATION WITH MARSHALL GOLDSMITH ABOUT LIVING AN EARNED LIFE

AbstractThis article is a conversation with Marshall Goldsmith, one of the world’s leading executive educators, coaches, and authors; and Leader to Leader co‐editor‐in‐chief Sarah McArthur, Goldsmith’s former managing editor. They discuss the principles behind Goldsmith’s new, best‐selling book The Earned Life. “We are living an earned life,” according to Goldsmith, “when the choices, risks, and effort we make in each moment align with an overarching purpose in our lives, regardless of the eventual outcome.” He continues: “Experience has taught me that there is at least one universal baseline motivation guaranteed to clarify our desire to live an earned life, and to make progress toward an overarching purpose and it is this: We want to live a life that will increase our fulfillment and minimize our regret.” Goldsmith relates the background to one of his most significant initiatives: “A number of years ago I started the 100 Coaches pay‐it‐forward community. It didn’t start as the 100 Coaches; it started as 15 Coaches. In fact, it didn’t even start as 15 Coaches, it started as an idea, a desire to connect my daily activities to a greater purpose.” He also points personal heroes: “Alan Mulally, Frances Hesselbein, Jim Yong Kim, Paul Hersey, Peter Drucker, and of course Buddha.”

Examining socio-cognitive factors and beliefs about mindful eating in healthy adults with differing practice experience: a cross-sectional study

BackgroundMindful eating (ME), defined as a “non-judgmental awareness of bodily and emotional sensations regarding food consumption”, may be a promising strategy to promote healthy eating behaviors. However, little is known about the psychosocial factors and underlying beliefs that explain ME adoption. MethodsParticipants (N = 282; Mage = 43.2) responded to an online questionnaire based on the I-Change Model. Groups with different frequencies of prior engagement in ME, i.e., low (n = 82; LME), medium (n = 96), and high (n = 104), were compared via (M)ANOVAs on factors and individual beliefs regarding predisposing (i.e., habits, experience with mindfulness, emotional eating, facets of ME), pre-motivational (i.e., knowledge, behavioral cognizance, risk perception, cues to action), and motivational factors (i.e., attitudes, self-efficacy, social influence) as well as their intentions and action planning. Bivariate correlations and a forward-stepwise regression with ICM constructs were conducted to examine model fit.ResultsLME had a greater habit of mindless eating and significantly lower internal awareness, cognizance, cues, and less favorable attitudes, self-efficacy, engagement and support by their social environment, intention, and action plans about engaging in ME than the other two groups. Less habitual mindless eating, and greater experience, internal awareness, cognizance, susceptibility, support, and intention explained 54% of the variance in ME.Discussion and conclusionResults indicate that individuals need to be treated differently when promoting ME with respect to their psychosocial characteristics, rather than as a single group with homogenous baseline beliefs, abilities, support, and motivation. Future longitudinal research should examine which determinants are predictors of ME to better tailor program contents.

No Effects of a Brief Mindfulness Intervention on Controlled Motivation and Amotivation, but Effect Moderation Through Trait Mindfulness: a Randomized Controlled Trial

ObjectivesMindfulness is associated with the different forms of motivation according to self-determination theory (intrinsic, identified, and external motivation, and amotivation). However, causal evidence for reported negative associations of mindfulness with external motivation and amotivation is currently lacking. Therefore, this study investigated causal effects of a brief mindfulness intervention on motivation towards a personal goal. We differentiated distinct forms of motivation and also controlled for baseline motivation and trait mindfulness, which could act as a moderator of the interventional effects.MethodsData of N = 91 participants were used, who were randomly assigned to either audio-guided meditation or a control condition. Situational motivation for a personal goal was assessed before and after the intervention. Trait mindfulness was measured with the Five Facet Mindfulness Questionnaire.ResultsThe intervention had a positive effect on the more autonomous forms of motivation (d = 0.48), which was, however, qualified by trait mindfulness; i.e., the effect was larger among participants low in trait mindfulness (d = 1.13 at 1 SD below the overall mean). There were no practically relevant effects on external motivation and amotivation.ConclusionsMindfulness has a positive causal effect on more autonomous forms of motivation, but probably no relevant effects on external motivation and amotivation. Moderating effects of trait mindfulness need to be considered more systematically in this field of research, but also in research of mindfulness intervention more generally. Mindfulness interventions could be beneficially offered to persons low in trait mindfulness.

Digitally Delivered Exercise and Education Treatment Program for Low Back Pain: Longitudinal Observational Cohort Study.

BackgroundExercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding the treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are an emerging way of delivering first-line treatment.ObjectiveThe aim of this study is to evaluate outcomes after participation in a 3-month digitally delivered treatment program for individuals with subacute or chronic LBP.MethodsWe analyzed data from 2593 consecutively recruited participants in a digitally delivered treatment program, available via the national health care system in Sweden. The program consists of video-instructed and progressive adaptable exercises, education through text lessons, and a chat and video function connecting participants with a personal physiotherapist. The primary outcome was mean change and proportion reaching a minimal clinically important change (MCIC) for LBP (2 points or 30% decrease) assessed with the numerical rating scale (average pain during the past week, discrete boxes, 0-10, best to worst). Secondary outcomes were mean change and proportion reaching MCIC (10 points or 30%) in disability, assessed with the Oswestry Disability Index (ODI; 0-100, best to worst) and a question on patient acceptable symptom state (PASS).ResultsThe mean participant age was 63 years, 73.85% (1915/2593) were female, 54.72% (1419/2593) had higher education, 50.56% (1311/2593) were retired, and the mean BMI was 26.5 kg/m2. Participants completed on average 84% of the prescribed exercises and lessons, with an adherence of ≥80% in 69.26% (1796/2593) and ≥90% in 50.13% (1300/2593) of the participants. Mean reduction in pain from baseline to 3 months was 1.7 (95% CI –1.8 to –1.6), corresponding to a 35% relative change. MCIC was reached by 58.50% (1517/2593) of participants. ODI decreased 4 points (95% CI –4.5 to –3.7), and 36.48% (946/2593) reached an MCIC. A change from no to yes in PASS was seen in 30.35% (787/2593) of participants. Multivariable analysis showed positive associations between reaching an MCIC in pain and high baseline pain (odds ratio [OR] 1.9, 95% CI 1.6-2.1), adherence (OR 1.5, 95% CI 1.3-1.8), and motivation (OR 1.2, 95% CI 1.0-1.5), while we found negative associations for wish for surgery (OR 0.6, 95% CI 0.5-0.9) and pain in other joints (OR 0.9, 95% CI 0.7-0.9). We found no associations between sociodemographic characteristics and pain reduction.ConclusionsParticipants in this digitally delivered treatment for LBP had reduced pain at 3-month follow-up, and 58.50% (1517/2593) reported an MCIC in pain. Our findings suggest that digital treatment programs can reduce pain at clinically important levels for people with high adherence to treatment but that those with such severe LBP problems that they wish to undergo surgery may benefit from additional support.Trial RegistrationClinicalTrials.gov NCT05226156; https://clinicaltrials.gov/ct2/show/NCT05226156

Mechanisms of self-persuasion intervention for HPV vaccination: Testing memory and autonomous motivation.

Objective: Optimizing a self-persuasion intervention app for adolescent HPV vaccination requires investigating its hypothesized mechanisms. Guided by the experimental medicine approach, we tested whether (a) self-persuasion intervention components (verbalize vaccination reasons, choose HPV topics) changed putative mechanisms (memory, autonomous motivation) and (b) measures of the putative mechanisms were associated with HPV vaccination. Method: These are secondary analyses from a randomized 2 (cognitive processing: verbalize reasons vs. listen) × 2 (choice: choose HPV topics vs. assigned) factorial trial (Tiro et al., 2016). Undecided parents (N = 161) with an unvaccinated child (11-17 years old) used the self-persuasion app, recalled reasons for vaccination (memory measure), and completed an autonomous motivation measure. Adolescent vaccination status was extracted from electronic medical records 12 months postintervention. Results: The verbalize component resulted in greater recall accuracy of vaccination reasons (p < .001); however, the choose topics component did not increase autonomous motivation scores (p = .74). For associations with HPV vaccination, recall accuracy was not associated (ps > .51), but autonomous motivation scores significantly predicted vaccination (ps < .03), except when controlling for baseline motivation (p = .22). Conclusion: The intervention app engages parents in reasons for vaccination; however, memory may not be a viable mechanism of vaccination. Although the intervention did not affect autonomous motivation, associations with vaccination status suggest it is a viable intervention target for HPV vaccination but alternative strategies to change it are needed. Future testing of a refined app should examine implementation strategies to optimize delivery in clinical or community settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pain induces adaptations in ventral tegmental area dopamine neurons to drive anhedonia-like behavior.

The persistence of negative affect in pain leads to co-morbid symptoms such as anhedonia and depression-major health issues in the United States. The neuronal circuitry and contribution of specific cellular populations underlying these behavioral adaptations remains unknown. A common characteristic of negative affect is a decrease in motivation to initiate and complete goal-directed behavior, known as anhedonia. We report that in rodents, inflammatory pain decreased the activity of ventral tegmental area (VTA) dopamine (DA) neurons, which are critical mediators of motivational states. Pain increased rostromedial tegmental nucleus inhibitory tone onto VTA DA neurons, making them less excitable. Furthermore, the decreased activity of DA neurons was associated with reduced motivation for natural rewards, consistent with anhedonia-like behavior. Selective activation of VTA DA neurons was sufficient to restore baseline motivation and hedonic responses to natural rewards. These findings reveal pain-induced adaptations within VTA DA neurons that underlie anhedonia-like behavior.

Causal pathways to social and occupational functioning in the first episode of schizophrenia: uncovering unmet treatment needs.

We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. Demographic, clinical, and psychosocial measures were obtained for 276 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and 6-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and 6-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N = 187). In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation [Effect size (ES) = 0.77], and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own 6-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. In our data-generated model, baseline socio-affective capacity and motivation are the most direct causes of occupational and social functioning 6 months after entering treatment in early schizophrenia. These findings indicate that socio-affective abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery.

Periodontal health education session can improve oral hygiene in patients with gingivitis: A masked randomized controlled clinical study.

The aim of this clinical trial was to evaluate the effect of a periodontal health education session (PHES), which included education on the pathogenesis and consequences of periodontal diseases on oral hygiene motivation in patients with gingivitis. A randomized controlled clinical trial was conducted on 50 (26 females and 24 males) patients with gingivitis who underwent periodontal treatment. Subjects were randomly allocated into the PHES group (experimental group) and standard oral hygiene education group (control group). The Rustogi Modified Navy Plaque Index (RMNPI) and Papillary Bleeding Index (PBI) were used to evaluate oral hygiene at baseline and were repeated after 1, 3, and 6 months. Knowledge about periodontal disease was measured and the participants' motivation was determined using the Oral Hygiene Motivation Scale. Although baseline knowledge levels and motivation scores were not different between the groups, following the educational motivational interviewing (MI) session, levels were higher in the experimental compared with the control group. The subjects' RMNPI and PBI scores at the 1-, 3-, and 6- month re-examinations were statistically higher in the control group than the experimental group. Furthermore, the level of knowledge and intrinsic and total motivation scores were moderately positively correlated with a reduction in clinical indices at 6 months compared with baseline. The results of this study indicated that increased knowledge and awareness about periodontal diseases and its consequences, including systemic effects, via educational MI session increased intrinsic motivation and improved oral hygiene of patients with gingivitis, especially regarding interproximal surfaces.

Perspectives on implementing HIIT interventions for service users in inpatient mental health settings: a qualitative study investigating patient, carer and staff attitudes

AimsHigh intensity interval training (HIIT) may improve a range of physical and mental health outcomes among people with severe mental illnesses (SMI). However, there is limited data on patients’ reported attitudes towards HIIT and its implementation within inpatient settings, and there remains an absence of data on attitudes towards HIIT from informal family carers of service users and healthcare professionals, who both have key roles to play in facilitating recovery outcomes in service users. This study sought to qualitatively investigate, in inpatients with SMI, carer and staff groups, perspectives on implementing HIIT interventions for patient groups in inpatient settings.MethodSeven focus groups and one individual interview were conducted. These included three focus groups held with inpatients with SMI (n = 12), two held with informal carers (n = 15), and two held with healthcare professionals working in inpatient settings (n = 11). An additional individual interview was conducted with one patient participant. The focus group schedule comprised open- ended questions designed to generate discussion and elicit opinions surrounding the introduction of HIIT on inpatient mental health wards. Data were subject to a thematic analysis.ResultTwo key themes emerged from the data, across all participants, that reflected the ‘Positivity’ in the application of HIIT interventions in psychiatric inpatient settings with beliefs that it would help patients feel more relaxed, build their fitness, and provide a break from the monotony of ward environment. Moreover, the short length of HIIT sessions was deemed appealing to mitigate against difficulties that many inpatients can experience with motivation, interest and attention, and was considered to be more appealing than more lengthy forms of exercise, which may require greater physical exertion. The second theme related to ‘Implementation concerns’, that reflected subthemes about i) low patient motivation, particularly with older participants, those administered many medications, and for those with less positive memories of exercise ii) patient safety, including concerns surrounding the intensity of HIIT and inclusion of patients with physical health comorbidities and iii) practical logistical factors, including having access to the right sports clothing and staff availability to supervise HIIT.ConclusionHIIT for inpatients with SMI was actively endorsed by patients, carers and healthcare professionals. Patient safety and baseline motivation levels, and practical service considerations were all noted as potential barriers to successful implementation and are worth considering in preparation for trialing a new intervention.