Changes In Psychosocial Outcomes Research Articles

Gamified Interventions for Promoting the Psychosocial Well-Being of School-Aged Children: A Scoping Review.

Gamified health interventions can offer child-centered and tailored health-promoting strategies. Evidence suggests that its various mechanics foster engagement that can be utilized to promote health and well-being and influence health behavior. At present, psychosocial challenges among school-aged children are becoming a global predicament. We conducted a scoping review to explore the range and nature of evidence on gamified interventions for promoting the psychosocial well-being of school-aged children from the general population. We followed the Arksey and O'Malley framework and extracted sources of evidence from five databases. Our review findings were summarized with basic numerical analysis and provided with narrative accounts based on a gamification taxonomy and the Template for Intervention Description and Replication (TIDieR). We identified 12 gamified interventions and included 23 records that reported their development and evaluation. Theories on emotions, behaviors, social skills, and mental health were commonly applied frameworks. Narrative was found as the most commonly used gamification mechanic (11/12, 91.7%), followed by avatar and tasks (10/12, 83.3%), feedback system and level progression (9/12, 75%), points (7/12, 58.3%), badges (5/12, 41.7%), progress bar (4/12, 33.3%), and virtual goods, reminders, and time pressure (2/12, 16.7%). The included sources of evidence reported significant improvements in some of the measured psychosocial outcomes; however, studies on this domain for this particular target group are still considerably limited. Further research is needed to determine how the applied theories and gamification mechanics brought about the change in psychosocial outcomes, bridging the gap in current evidence.

Vision and hearing problems and psychosocial outcomes: longitudinal evidence from the German Ageing Survey

PurposeTo examine whether changes in vision and hearing problems are associated with changes in psychosocial outcomes (in terms of depressive symptoms, loneliness, and perceived social isolation).MethodsWe used longitudinal data from the nationally representative German Ageing Survey, which covers individuals aged 43 years and over (wave 6 and wave 7, with 7108 observations and mean age of 67.5 years, SD 10.2 years). The 6-item De Jong Gierveld tool was used to quantify loneliness, the Bude and Lantermann tool was used to quantify perceived social isolation, and the Center for Epidemiologic Studies Depression Scale (15-item version) was used to quantify depressive symptoms. Self-rated problems reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used to quantify vision problems. In addition, self-rated hearing problems on the telephone and self-rated hearing problems in groups of more than four people were used to quantify hearing problems.ResultsAdjusting for various confounders, longitudinal regressions showed that the onset of major vision problems referring to difficulties recognizing people one knows on the street was associated with increases in loneliness (β = 0.17, p < .01) and depressive symptoms (β = 1.90, p < 0.05). Moreover, the onset of some vision problems referring to difficulties reading the newspaper was associated with increases in perceived social isolation (β = 0.06, p < 0.01). Additionally, the onset of some hearing problems in groups of more than four people was associated with increases in depressive symptoms (β = 0.43, p < 0.05).ConclusionOur longitudinal study showed that vision and hearing problems can contribute differently to psychosocial factors. Delaying sensory impairment may result in favorable psychosocial factors in later life.

Boabom: A Feasible and Acceptable Approach to Helping College Students Manage Stress.

Objective: College students in the United States report high rates of psychological health concerns. Psychological and physical complementary health approaches have been found to be protective for college students. The aims of this study were to assess the feasibility and acceptability of Boabom, a martial art, with college students and to explore any changes in psychosocial outcomes. Participants: Twenty-six college students (25 females; mean age 21.73 years) participated in an 8-week Boabom intervention. Methods: Feasibility measures were attendance and retention of participants; acceptability was based on participants' cognitive and emotional responses to Boabom and was determined through analysis of focus group data. Psychosocial outcomes were assessed through analyses of pre- and postintervention measures of mindfulness, perceived stress, anxiety, depression, resilience, perceived health, and life satisfaction. Results: The Boabom intervention was feasible as 23 of 26 participants attended at least six of eight classes, and 22 participants attended the last class. Students found the intervention acceptable, with three themes emerging from the focus group data to describe the participants' experience with Boabom: (1) disengaging from constant, daily stress and breathing and moving as a group leads to sense of calm, (2) empowerment through incremental mastery of skills, and (3) recognition of the value of health benefits to be gained. Participants reported positive changes in mindfulness, perceived stress, anxiety, depression, resilience, perceived health, and life satisfaction from pre- to postintervention. Conclusions: Boabom may be a feasible and acceptable offering for college students; still, further piloting with other college student populations is recommended.

Psychosocial Outcomes with the Omnipod® 5 Automated Insulin Delivery System in Children and Adolescents with Type 1 Diabetes and Their Caregivers

Objective. While automated insulin delivery (AID) systems aim to improve glycemic outcomes, the opportunity to improve psychosocial outcomes is also of critical importance for children and adolescents with type 1 diabetes and their caregivers. We evaluated psychosocial outcomes in these groups during a clinical trial of a tubeless AID system, the Omnipod® 5 Automated Insulin Delivery System. Methods. This single-arm, multicenter, prospective study enrolled 83 children (6.0–11.9 years) and 42 adolescents (12.0–17.9 years) with type 1 diabetes to use a tubeless AID system for 3 months. Participants and their caregivers completed age- and role-appropriate validated questionnaires to assess changes in psychosocial outcomes—diabetes distress (PAID), hypoglycemia confidence (HCS), well-being (WHO-5), sleep quality (PSQI), insulin delivery satisfaction (IDSS), and system usability (SUS)—before and after 3 months of AID system use. Associations between participant characteristics and glycemic outcomes with psychosocial measures were evaluated using linear regression analyses. Results. Improvements were found for children, adolescents, and/or their caregivers for diabetes-related distress, insulin delivery satisfaction, and system usability (all P &lt; 0.05 ). Caregivers of children saw additional benefits of improved general well-being, confidence in managing hypoglycemia, and sleep quality (all P &lt; 0.05 ). Regression analyses showed that improvements in psychosocial outcomes were generally independent of baseline characteristics and changes in glycemic outcomes. Conclusions. The tubeless AID system was associated with significant improvements in a number of psychosocial outcomes for children, adolescents, and their caregivers. Trial registration: This trial is registered with NCT04196140.

169-LB: Neuropsychological Consultation and Glycemic Control in Pediatric Patients

Executive function underlies the ability to plan, reason, and problem solve - skills essential to diabetes management. Children with T1D are at elevated risk of executive dysfunction. Providing families with supports to acknowledge and address these deficits may improve diabetes outcomes. In a randomized controlled trial, we evaluated whether neuropsychological consultation improved glycemic control. From July 2019-September 2020 we enrolled patients aged 10-17 years with T1D ≥6 months. Participants were randomized at enrollment to neuropsychological consultation (n=26) or usual care (n=24). Both groups completed executive function and psychosocial assessments at baseline and follow-up plus received diabetes management education. The intervention group also underwent neuropsychological consultation followed by focused feedback. Follow-up for both groups extended for 12 months. We assessed whether neuropsychological consultation was associated with change in HbA1C from baseline to follow-up using age and sex-adjusted linear regression models in intention-to-treat and per protocol analyses. At baseline, the mean (SD) age of participants was 13.8 (2.4) years with 51% in grades 5-8 and 49% in grades 9-12. Mean (SD) HbA1c was 7.7% (1.7); most participants used CGMs (94%) and insulin pumps (87%). Thirty-five percent of the intervention group met criteria for executive dysfunction. HbA1C was lower at follow-up in the treatment group according to both the intention-to-treat (-1.3%; 95% CI -2.5, -0.1) and per protocol (-1.3%; 95% CI -2.6, 0.1) analyses. This small randomized controlled trial performed primarily during the COVID-19 pandemic demonstrates that neuropsychological consultation may contribute to improvement in glycemic control among pediatric patients with T1D. Next steps include examining changes in psychosocial outcomes, identifying the most impactful aspects of the consultation, and studying this intervention in a larger patient population. Disclosure J. E. Gonzalez: None. C. R. Stein: None. J. Ilkowitz: None. S. Powell: None. M. Gallagher: None.

Twelve-month psychosocial outcomes of continuous glucose monitoring with behavioural support in parents of young children with type 1 diabetes.

Managing type 1 diabetes in young children can cause significant stress for parents. Continuous glucose monitoring (CGM) may reduce parental burden. The Strategies to Enhance CGM Use in Early Childhood (SENCE) trial randomized parents of children (ages 2 to <8 years) with type 1 diabetes to CGM with family behavioural intervention (CGM + FBI), CGM alone (Standard-CGM) or blood glucose monitoring for 26 weeks before receiving CGM + FBI (BGM-Crossover). This report assesses changes in psychosocial outcomes for all groups over 52 weeks. CGM + FBI (n = 45), Standard-CGM (n = 42) and BGM-Crossover (n = 44) participants completed psychosocial assessments at baseline, 26 weeks and 52 weeks. Repeated measures linear regression models evaluated change within and between treatment groups. The BGM-Crossover group reported improved diabetes burden (Δ -6.9, 95% CI [-11.3, -2.6], p = 0.003), fear of hypoglycaemia (Δ -6.4, CI [-10.1, -2.6], p = 0.002) and technology satisfaction (Δ 7.3, CI [2.4, 12.2], p = 0.005) from 26 to 52 weeks, similar to published findings in the CGM + FBI group over the first 26 weeks. The Standard-CGM group reported increased technology satisfaction (Δ 7.3, CI [0.6, 14.0], p = 0.027) from baseline to 52 weeks. The CGM + FBI group reported less diabetes burden and fear of hypoglycaemia from baseline to 52 weeks, but changes were not statistically significant. Scores from 26 to 52 weeks did not deteriorate. Parents demonstrated psychosocial benefits following FBI that appeared to maintain without additional intervention. CGM-focused education with behavioural support likely helps parents of young children with type 1 diabetes reduce burden and worry in the short- and long-term.

Self-reported efficacy in patient-physician interaction in relation to anxiety, patient activation, and health-related quality of life among stroke survivors

Background Early detection of AF is critical for stroke prevention. Several commercially available smartwatches are FDA cleared for AF detection. However, little is known about how patient-physician relationships affect patients’ anxiety, activation, and health-related quality of life when prescribed smartwatch for AF detection. Methods Data were used from the Pulsewatch study (NCT03761394), which randomized adults (>50 years) with no contraindication to anticoagulation and a CHA2DS2-VASc risk score ≥2 to receive a smartwatch-smartphone app dyad for AF monitoring vs. conventional monitoring with an ECG patch (Cardea SoloTM) and monitored participants for up to 45 days. The Perceived Efficacy in Patient-Physician Interactions survey was used to assess patient confidence in physician interaction at baseline with scores ≥45 indicating high perceived efficacy in patient-provider interactions. Generalized Anxiety Disorder-7 Scale, Consumer Health Activation Index, and Short-Form Health Survey were utilized to examine anxiety, patient activation, and physical and mental health status, at baseline, 14, and 44 days, respectively. We used mixed-effects repeated measures linear regression models to assess changes in psychosocial outcomes among smartwatch users in relation to self-reported efficacy in physician interaction over the study period. Results A total of 93 participants (average age 64.1 ± 8.9 years; 43.0% female; 88.2% non-Hispanic white) were included in this analysis. At baseline, fifty-six (60%) participants reported high perceived efficacy in patient-physician interaction. In the fully adjusted models, high perceived efficacy (vs. low) at baseline was associated with greater patient activation and perceived mental health (β 12.0, p-value <0.001; β 3.39, p-value <0.05, respectively). High perceived self-efficacy was not associated with anxiety or physical health status (β − 0.61, p-value 0.46; β 0.64, p-value 0.77) among study participants. Conclusions Higher self-efficacy in patient-physician interaction was associated with higher patient activation and mental health status among stroke survivors using smartwatches. Furthermore, we found no association between anxiety and smartwatch prescription for AF in participants with high self-efficacy in patient-physician interaction. Efforts to improve self-efficacy in patient-physician interaction may improve patient activation and self-rated health and subsequently may lead to better clinical outcomes. KEY MESSAGES Higher self-efficacy in patient-physician interaction was associated with higher patient activation and mental health status among stroke survivors using smartwatches. No association between anxiety and smartwatch prescription for AF in participants with high self-efficacy in patient-physician interaction. Efforts to improve self-efficacy in patient-physician interaction may improve patient activation and self-rated health and subsequently may lead to better clinical outcomes.

Evaluating differences in setting expected body weight for children and adolescents in eating disorder treatment.

Weight restoration or weight gain is a common goal in eating disorder treatment. However, approaches to determine expected body weight (EBW) vary. A standardized approach based on normative data for a patient's age and gender uses weight associated with median BMI (mBMI). An individualized approach predicts EBW based on a patient's individual growth trajectory. Little research has examined differences in these approaches. Weight and clinical data were collected from patients ages 6-20 enrolled in virtual eating disorder treatment. EBW associated with mBMI was compared with EBW using the individualized approach. Linear mixed effects models examined differences in weight, eating disorder symptoms, depression, and anxiety, and whether EBW approach varied by patient characteristics. Patients (N=609) were on average age 15.6 (2.29), 85% were cisgender female, and predominantly diagnosed with anorexia nervosa (83.1%). The individualized approach led to significantly higher EBW on average (mean difference=8.4lbs [SE: .75]; p < .001) compared to mBMI; 70% of patients had a higher EBW using the individualized approach. Notably, EBW varied based on gender and diagnosis and it took longer on average to achieve individualized EBW. Time was the strongest predictor of changes in psychosocial outcomes and there were no significant differences by EBW approach. Results from this study indicate that an individualized approach led to significantly higher EBWs compared with using mBMI. As underestimation of EBW may lead to higher risk of relapse, eating disorder professionals should consider using an individualized approach for setting EBW. For eating disorder patients who need to gain weight, accurately estimating target body weight for eating disorder treatment is critical to recovery and preventing relapse. An individualized, patient-centered approach to estimating target body weight more accurately estimated target body weight than the standardized, median body mass index approach. Using an individualized approach to treatment may improve a patient's likelihood of full recovery.

Examining I‐CONECT Intervention Effect on Psychosocial Wellbeing

AbstractBackgroundThe Internet‐based Conversational Engagement Clinical Trial (I‐CONECT, ClinicalTrials.gov:NCT02871921) intervention provided interpersonal interactions with video calls to socially isolated older adults. It is hypothesized that such intervention could improve individuals' psychosocial wellbeing by increasing social contacts. This abstract examines I‐CONECT intervention effects on psychological wellbeing outcomes.MethodThe intervention group received 30‐minute video chats 4 times/week for 6 months followed by 2 times/week for additional 6 months. The control group received weekly check‐in calls for 12 months. We used data from the baseline, six‐month and twelve‐month follow‐ups. Psychosocial outcomes were measured with NIH Toolbox Emotional Battery (NIHTB‐EB). Three domain scores, negative affect, social satisfaction, and psychological wellbeing, were calculated with 17 subscale scores weighted by factor loading. Mixed Models for Repeated Measures (MMRM) were run for the three psychosocial outcomes, controlling for age, sex, education, and experience of COVID‐19 pandemic. Participants were considered affected by COVID‐19 if any of the data points were collected after March 2020. Subsample analyses were conducted by participants' cognitive status (with normal cognition vs. MCI).ResultThe analysis included 134 participants, 70 with normal cognition and 64 with MCI. The sample’s mean age was 82.3, 44.9% were in the intervention group, 67.0% were female, the average year of education was 15.1, and 51.6% were affected by the pandemic. For the subsamples of individuals of normal cognition and MCI, we did not find any significant change in psychosocial outcomes due to the intervention. However, both intervention and control groups increased social satisfaction scores at both 6‐month and 12‐month (Table 1, Figure 1), suggesting that weekly phone check‐ins and frequent video‐chats interactions can provide the same magnitude of improvement in psychosocial wellbeing. We observed the COVID‐19 pandemic affected social satisfaction of both intervention and control groups negatively for those with MCI but did not affect the individuals with normal cognition.ConclusionBoth intervention and control groups improved in a measure of social satisfaction. Once per week 10‐minutes phone check‐ins provided for the control group seemed to be sufficient for improving social wellbeing. Implementing weekly phone check‐ins in the community might help improve psychological wellbeing among socially isolated older adults.

The Influence of Real-Time Continuous Glucose Monitoring on Psychosocial Outcomes in Insulin-Using Type 2 Diabetes.

To examine the impact of real-time continuous glucose monitoring (rtCGM) on psychosocial outcomes in adults with insulin-using type 2 diabetes (T2D). A total of 174 insulin-using adults with T2D completed questionnaires assessing diabetes distress, hypoglycemic confidence, hypoglycemic fear, device-related emotional burden, and device-related trust before and after a six-month trial of rtCGM. Hemoglobin A1c (HbA1c) was assessed at the same time points; impaired hypoglycemic awareness (IAH) was assessed at baseline. Change in psychosocial outcomes was examined with t tests, then modeled as a function of baseline HbA1c and IAH and simultaneous change in HbA1c in multiple regression analyses. Respondents were predominantly male (57.5%) and non-Hispanic white (67.8%). Significant improvement over the trial was observed in hypoglycemic fear (P = .031), hypoglycemic confidence (P < .001), diabetes distress (P < .001), and device-related emotional burden (P < .001). Impaired hypoglycemic awareness at baseline predicted greater improvement in hypoglycemic fear (P = .002), hypoglycemic confidence (P = .003), diabetes distress (P = .013), and device-related emotional burden (P < .001). Higher baseline HbA1c was linked with greater improvement in hypoglycemic fear (P = .030); HbA1c change over the trial was positively associated with change in diabetes distress (P = .010) and device-related emotional burden (P = .003). Introduction of rtCGM in adults with insulin-using T2D was associated with significant improvements in diabetes-related psychosocial outcomes over six months. Gains were significantly greater among participants reporting IAH and those with higher HbA1c at baseline, thus providing the first evidence regarding which users might more likely benefit.

High levels of depressive symptoms and low quality of life are reported during pregnancy in Cape Coast, Ghana; a longitudinal study.

BackgroundSignificant rates of anxiety, depressive symptoms, and low quality of life (QoL) have been found among pregnant women in developed countries. These psychosocial disturbances have not been adequately assessed during pregnancy in many developing countries.MethodsWomen were recruited in their first trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2nd (n = 71) and 3rd (n = 71) trimesters. Questionnaires were used to collect data on anxiety symptoms (Beck Anxiety Inventory; BAI), depressive symptoms (Center for Epidemiological Studies-Depression Inventory; CES-D), and quality of life (RAND SF-36; QoL). Psychometric analyses were used to determine the reliability of the questionnaires in this context. The proportion of pregnant women with psychosocial disturbances at each trimester was determined. Repeated measures ANOVA were used to examine changes in psychosocial outcomes over time; and generalized estimating equation to determine if gestational age predicted the psychosocial outcomes whilst controlling for sociodemographic variables.ResultsParticipants were aged 27.1 ± 5.2 years, on average. Psychometric analyses revealed a 4-factor solution for BAI (18 items), 1-factor solution for CES-D (13 items) and 4-factor solution for RAND SF-36 (26 items). The prevalence estimate of psychosocial disturbances was 34%, 10%, 2% (anxiety), 49%, 31%, 34% (depressive symptoms), and 46%, 37%, 59% (low QoL) for 1st, 2nd and 3rd trimesters, respectively. Gestational age and food insecurity were significant predictors of depressive symptoms, anxiety symptoms and QoL.ConclusionsIn this population of Ghanaian women, the levels of depressive symptoms and low QoL observed across pregnancy should be recognized as major public health problems and efforts to address these should be put in place. Addressing food insecurity may be a major step to solve not only the physical needs of the pregnant woman but also the psychological needs.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-022-13299-2.

Adolescents' psychosocial well-being one year after the outbreak of the COVID-19 pandemic in Norway.

The COVID-19 pandemic has dramatically restricted adolescents' lives. We used nationwide Norwegian survey data from 2014-2021 (N = 227,258; ages 13-18) to examine psychosocial outcomes in adolescents before and during the pandemic. Multilevel models revealed higher depressive symptoms and less optimistic future life expectations during the pandemic, even when accounting for the measures' time trends. Moreover, alcohol and cannabis use decreased, and screen time increased. However, the effect sizes of all observed changes during the pandemic were small. Overall, conduct problems and satisfaction with social relationships remained stable. Girls, younger adolescents and adolescents from low socio-economic backgrounds showed more adverse changes during the pandemic. Estimated changes in psychosocial outcomes varied little with municipality infection rates and restrictions. These findings can inform means and interventions to reduce negative psychological outcomes associated with the pandemic and identify groups that need particular attention during and after the pandemic.

Psychosocial trajectories before and after spousal loss: Does gender matter?

RationalePrior studies have suggested that spousal loss can have negative impacts on widowed persons’ lives. However, few studies have examined whether time since spousal loss is related to changes in psychosocial outcomes and there are gender differences in psychosocial trajectories in response to spousal loss. ObjectiveThis study examines the psychosocial trajectories (depressive symptoms and social engagement) of widowed individuals before and after spousal death. This study also investigates whether psychosocial adjustment trajectories, among individuals who experienced spousal loss, are gendered. MethodsThis study uses data from 685 middle- and older-aged adults over seven waves (4284 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. This study estimates fixed effects models to account for observed and unobserved individual-level heterogeneity. Gender-stratified fixed effects regression models are used to investigate whether psychosocial changes associated with spousal loss differ by gender. ResultsPsychosocial adjustment to spousal loss is strikingly gendered. Among men, depressive symptoms began to increase within the first year following spousal loss and continued through the fourth and subsequent years. In contrast, depressive symptoms among widows did not change significantly during and after bereavement. Similar patterns were found for social engagement. Among men, a decrease in frequency of social interactions and participation in social activities was found from the first year of spousal loss to the fourth and subsequent years. No such patterns were found for women. ConclusionSpousal loss is a life event that spurs tremendous psychosocial changes for widowed people. This study suggests that spousal loss-associated psychosocial changes occur over a long period of time and are greater in men than in women.

Chronic difficulties are associated with poorer psychosocial functioning in the first year post-diagnosis in epithelial ovarian cancer patients.

Ovarian cancer is characterized by poor prognosis, high levels of distress, disturbed sleep, and compromised quality of life (QOL). Although life stressors have been shown to significantly impact physical and psychological health in cancer populations, no studies have used a high-resolution stress assessment to differentiate effects of acute versus chronic stressors among women with ovarian cancer. We addressed this issue in the present prospective longitudinal study by examining how acute and chronic stress exposure in the year pre-diagnosis relate to depressive symptoms, sleep quality, and QOL over the first year post-diagnosis in women with ovarian cancer. One hundred thirty-seven women completed the Life Events and Difficulties Schedule within a month of initial treatment for suspected ovarian cancer. Depressive symptoms, sleep, and QOL were measured pre-treatment, at six months, and one-year post-diagnosis. Mixed models were used to examine associations of acute and chronic stress pre-diagnosis with (a) change in psychosocial outcomes over the first year post-diagnosis and (b) levels of psychosocial outcomes across all time points. Both the number and severity of chronic difficulties (but not acute life events) were related to significantly greater depression, and poorer sleep quality and QOL, across all time-points. In contrast, these stress indices were unrelated to changes in psychosocial functioning over time. Chronic but not acute stress exposure predicted average levels of depression, sleep, and QOL in the first year post-diagnosis among women with ovarian cancer. Assessing stressors and designing interventions for reducing stress may thus be beneficial for ovarian cancer patients.

Feasibility and acceptability of implementing the Making Friends with Yourself intervention on a college campus

Objective: To assess the feasibility and acceptability of Making Friends with Yourself (MFY): A Mindful Self-Compassion Program for Teens and Young Adults with a sample of college students. A secondary objective was to explore changes in psychosocial outcomes. Participants: Twenty-five students (23 females; mean age 20.35 years) enrolled in the 8-week intervention. Methods: Feasibility was measured by attendance and retention of participants; acceptability was determined through analysis of focus group data. Psychosocial outcomes were assessed through analyses of pre- and post-intervention measures. Results: The intervention was feasible as 20 students attended at least seven of eight classes, and 21 completed the program. Students found the intervention acceptable and reported significant increases in mindfulness and self-compassion and decreased perceived stress from pre- to post-intervention. However, academic stress increased. Conclusions: MFY may be a feasible and acceptable program to offer to college students. Further piloting in college student populations is recommended.

Psychosocial Outcomes of Australian Male and Female Veterans Following Participation in Peer-Led Adventure-Based Therapy

Adjunct or second-line therapies are increasingly being utilised among military populations to address treatment barriers and improve mental health outcomes. This study evaluated the psychosocial outcomes of an Australian peer-led adventure-based therapy program, Trojan’s Trek, for 60 ex-service military personnel (i.e., veterans, 56.7% male). Participants completed 1 of 6 Queensland Trojan’s Trek programs—a 6-day, live-in program consisting of 10–12 structured CBT-based group sessions and 11 nature-based activities—between March 2018 and March 2019. A non-controlled, within-subjects longitudinal design was utilised with assessment at pre-intervention, post-intervention, and 2-month follow-up. Changes in psychosocial outcomes were assessed using the Depression, Anxiety, and Stress Scale 21 (DASS-21), PTSD Checklist-5 (PCL-5), Positive and Negative Interactions Scale (PNI), General Self-Efficacy Scale (GSES), and the Life Satisfaction Questionnaire (LSQ). Mixed-factorial ANOVAs indicated a significant time x gender effect for anxiety (male <em>F</em>[2, 28] = 31.1, <em>p</em> &lt; .001; female <em>F</em>[2, 19] = 4.05, <em>p</em> = .025); and stress (male <em>F</em>[2, 28] = 45.3, <em>p</em> &lt; .001; female <em>F</em>[2, 19] = 9.98, <em>p</em> &lt; .001). There were significant improvements between pre- and post-intervention for depression, anxiety (male only), stress, posttraumatic stress, perceived positive relationships with friends and family, perceived negative relationships with family and partners, self-efficacy, and life satisfaction. Improvements were maintained or established at 2-month follow-up for depression, anxiety (male and female), stress, posttraumatic stress, perceived negative relationships with friends, and self-efficacy. This study demonstrates utility of the Trojan’s Trek program for male and female Australian veterans with mental health difficulties. However, a controlled trial is required to determine program efficacy.

Six months of hybrid closed loop in the real-world: An evaluation of children and young adults using the 670G system.

To describe glycemic and psychosocial outcomes in youth with type 1 diabetes using a hybrid closed loop (HCL) system. Youth with type 1 diabetes (2-25 years) starting the 670G HCL system for their diabetes care were enrolled in an observational study. Prospective data collection occurred during routine clinical care and included glycemic variables (sensor time in range [70-180 mg/dL], HbA1c), and psychosocial variables (Hypoglycemia Fear Survey [HFS]; Problem Areas in Diabetes [PAID]). Mixed models were used to analyze change across time. Ninety-two youth (mean age 15.7 ± 3.6 years, 50% female, HbA1c 8.8% ± 1.8%) started HCL for their diabetes care. Youth used Auto Mode 65.5% ± 3.0% of the time at month 1, which decreased to 51.2% ± 3.4% at month 6 (P = .001). Sensor time in range increased from 50.7% ± 1.8% at baseline to 56.9% ± 2.1% at 6 months (P = .007). HbA1c decreased from 8.7% ± 0.2% at baseline to 8.4% ± 0.2% after 6 months of use (P ≤ .0001), with the greatest HbA1c decline in participants with high baseline HbA1c. Increased percent time in auto mode was associated with lower HbA1c (P = .02). Thirty percent of youth discontinued HCL in the first 6 months of use. There were no changes in the HFS or PAID scores across time. HCL use is associated with improved glycemic control and no change in psychosocial outcomes in this clinical sample. The decline in HCL use across time suggests that youth experience barriers in sustaining use of HCL. Further research is needed to understand reasons for HCL discontinuation and determine intervention strategies.

Evaluation of a survivorship needs assessment planning tool for head and neck cancer survivor-caregiver dyads.

The objectives of this study were to test the acceptability and feasibility of a survivorship needs assessment planning (SNAP) tool for head and neck cancer (HNC) survivors and caregivers, evaluate short-term changes in psychosocial outcomes after completing the SNAP session, and develop strategies for system refinement. We used a prospective one-group design and mixed methods with HNC survivors and caregivers (N = 25 dyads). Participants completed baseline and 6-week surveys before and after completing a SNAP clinic visit to assess psychosocial outcomes and acceptability. Intervention sessions included tablet-based needs assessments driving tailored care plans. Dyads' open-ended feedback and clinician interviews (N = 12) evaluated acceptability and feasibility. SNAP data collection time burden and technology challenges were minimal, and care plans included messages (M= 19), educational materials (M = 13), and referrals (M = 4.5; 86% behavioral medicine, 77% nutrition, 65% physical therapy). Participants reported high satisfaction with the session and care plan, highlighting the key strengths of pulling complex medical information together and the focus on caregiver well-being, with multiple suggestions to facilitate clinic workflow. Depression and unmet needs decreased and survivorship knowledge increased significantly in survivors and caregivers (p < .05) over the 6-week period. The SNAP tool is an innovative technology-based survivor-centered strategy to assess and manage needs in HNC survivors and caregivers. Results support its acceptability and ability to address dyads' needs; the tool merits further testing in a clinical trial. Technology-enabled care planning may be a productive way to assess and address HNC dyads' dynamic needs after treatment.

Changes in the Participants in a Community-Based Positive Youth Development Program in Hong Kong: Objective Outcome Evaluation Using a One-Group Pretest-Posttest Design

Project “P.A.T.H.S.” has been shown to be effective in promoting positive development outcomes among Chinese adolescents in the school context. However, little is known whether the benefits can also be found in other settings. The purposes of the study was to investigate the changes in psychosocial outcomes among Hong Kong Chinese adolescents after participating in a community-based positive youth development (PYD) program. Using a one-group pretest-posttest design, junior high school students (N = 17,544) were invited to join the universal prevention program (the Tier 1 Program) and/or the selective prevention program (the Tier 2 Program). 10,807 students whose pre-and post-test data were successfully matched. The students responded to validated outcome measures assessing PYD outcomes, life satisfaction and thriving at pretest and posttest. Consistent with the hypotheses, students showed positive change on different developmental outcomes after joining the program. Amongst the different programs, students in the Tier 2 Program had significant improvement in all developmental outcome indicators. While limitations of the one-group pretest-posttest design and the alternative explanations are duly acknowledged, the present study suggests that the community-based Project P.A.T.H.S. is a promising approach to promote positive youth development, life satisfaction and thriving of adolescents, a conclusion which is consistent with the existing evaluation findings of the project. Building from previous school-based research, the present study extends the literature by showing the effectiveness of a positive youth prevention program in a community context. Limitations of the study design (e.g., an absence of a control group) are discussed.

A mobile phone-based program to promote healthy behaviors among adults with prediabetes: study protocol for a pilot randomized controlled trial

BackgroundRates of participation in Diabetes Prevention Programs (DPPs) are low. This may be due, in part, to low levels of autonomous motivation (i.e., motivation that arises from internal sources and sustains healthy behaviors over time) to prevent type 2 diabetes (T2DM) among many individuals with prediabetes. Mobile health (mHealth) technologies that incorporate principles from the Self-Determination Theory offer an effective and scalable approach to increase autonomous motivation levels. One promising mobile phone-based application is JOOL Health, which aims to help users connect certain health behaviors (e.g., sleep and diet) with personal values in specific life domains (e.g., family and work). The first aim of this study is to estimate whether JOOL Health can increase autonomous motivation to prevent T2DM among individuals with prediabetes who declined DPP participation. The second aim of this pilot study is to examine the intervention’s feasibility and acceptability.MethodsThis is a 12-week, three-arm pilot randomized controlled trial. We will recruit 105 individuals with prediabetes who did not engage in a DPP despite invitation from their health plan to participate in face-to-face or web-based programs at no out-of-pocket-cost. Participants will be randomized to one of three study arms: (1) a group that receives information on prediabetes, evidence-based strategies to decrease progression to T2DM, and a list of resources for mHealth tools for monitoring diet, physical activity, and weight (comparison group); (2) a group that receives the JOOL Health application; and (3) a group that receives the JOOL Health application as well as a Fitbit activity tracker and wireless-enabled scale. Our primary outcome is change in autonomous motivation to prevent T2DM (measured using the Treatment Self-Regulation Questionnaire). We will also collect data related to the intervention’s feasibility (recruitment and retention rates) and acceptability (adherence and qualitative experience) as well as changes in psychosocial outcomes, hemoglobin A1c, and weight.DiscussionTo our knowledge, this is the first study that aims to promote positive health behaviors among individuals with prediabetes who previously declined to participate in a DPP. Our results will inform a larger trial to test the effect of JOOL Health on clinically relevant outcomes, including weight loss, physical activity, and DPP engagement.Trial registrationNCT03025607. Registered February 2017.