Health Communication Interventions Research Articles

31.5 BEST PRACTICES OF POSTVENTION IN ACTION

Suicide postventions after a death by suicide are important community health interventions that are not discussed often enough despite the ongoing youth mental health crisis. Participants will learn about: 1) the public health effects of a suicide postvention; and 2) the basic components of a suicide postvention.

Research and Implementation Lessons Learned From a Youth-Targeted Digital Health Randomized Controlled Trial (the ARMADILLO Study).

BackgroundEvidence is lacking on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24 years), especially from low- and middle-income countries. Therefore, the World Health Organization initiated the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) program, a free, menu-based, on-demand text message (SMS, short message service) platform providing validated SRH content developed in collaboration with young people. A randomized controlled trial (RCT) assessing the effect of the ARMADILLO intervention on SRH-related outcomes was implemented in Kwale County, Kenya.ObjectiveThis paper describes the implementation challenges related to the RCT, observed during enrollment and the intervention period, and their implications for digital health researchers and program implementers.MethodsThis was an open, three-armed RCT. Following completion of a baseline survey, participants were randomized into the ARMADILLO intervention (arm 1), a once-a-week contact SMS text message (arm 2), or usual care (arm 3, no intervention). The intervention period lasted seven weeks, after which participants completed an endline survey.ResultsTwo study team decisions had significant implications for the success of the trial’s enrollment and intervention implementation: a hands-off participant recruitment process and a design flaw in an initial language selection menu. As a result, three weeks after recruitment began, 660 participants had been randomized; however, 107 (53%) participants in arm 1 and 136 (62%) in arm 2 were “stuck” at the language menu. The research team called 231 of these nonengaging participants and successfully reached 136 to learn reasons for nonengagement. Thirty-two phone numbers were found to be either not linked to our participants (a wrong number) or not in their primary possession (a shared phone). Among eligible participants, 30 participants indicated that they had assumed the introductory message was a scam or spam. Twenty-seven participants were confused by some aspect of the system. Eleven were apathetic about engaging. Twenty-four nonengagers experienced some sort of technical issue. All participants eventually started their seven-week study period.ConclusionsThe ARMADILLO study’s implementation challenges provide several lessons related to both researching and implementing client-side digital health interventions, including (1) have meticulous phone data collection protocols to reduce wrong numbers, (2) train participants on the digital intervention in efficacy assessments, and (3) recognize that client-side digital health interventions have analog discontinuation challenges. Implementation lessons were (1) determine whether an intervention requires phone ownership or phone access, (2) digital health campaigns need to establish a credible presence in a busy digital space, and (3) interest in a service can be sporadic or fleeting.Clinical TrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 85156148; http://www.isrctn. com/ISRCTN85156148

Knowledge of Health Insurance Terms and the Affordable Care Act in Racially and Ethnically Diverse Urban Communities.

Confusion around health insurance reforms persist. The purpose of this study was to assess demographic differences in Affordable Care Act (ACA) and health insurance knowledge in a multi-ethnic urban sample. Data came from 243 adults from racial/ethnic communities. Participants were asked about elements of health insurance and the ACA. Generalized linear and logistic regression models were used to examine relationships between demographic predictors and knowledge domains. Female gender (p < 0.05) and Latino/Hispanic race/ethnicity (p < 0.001) were most predictive of lower eligibility knowledge, while non-citizen with residency status (p < 0.001) and other/not declared residency status (p < 0.001) were most predictive of lower insurance coverage knowledge. No demographic factors predicted enrollment knowledge. Latino/Hispanic race/ethnicity (p < 0.01) was most predictive of not knowing that more people can get insurance because of the ACA. In conclusion, there is variation in health insurance and ACA-related knowledge in multi-ethnic populations. More compatible health communication interventions are needed to support outreach to key demographic groups.

Sexual and reproductive health communication intervention for caretakers of adolescents: a quasi-experimental study in Unguja- Zanzibar

BackgroundCaretakers/parents or parents figure need to be trained to promote effective communication about sexual and reproductive health to their adolescents. This study assessed the effect of an intervention aiming to improve caretaker-adolescent communication on sexual and reproductive health matters through improving information, motivation, and behavioral skills related to sexual health communication. The study also evaluated the relationship of information, motivation, and behavioral skills model-constructs with communication practice. Information-Motivation-Behavioural skills model was used as a framework to guide the intervention implementation and evaluation process.MethodThis is a quasi-experimental non-randomized controlled pre- and post-test study which involved one thousand caretakers of adolescents in all the six districts of Unguja-Zanzibar. All participants completed interviewer-administered structured pre-test questionnaire. The experimental group then received sexual health communication intervention addressing the information, motivation, and behavioral skills related to sexual health communication, while the control group received the sexual health information only. All participants were then reassessed for their information, motivation, behavioral skills and their sexual health communication after 1 month, 6 months and at 1 year following the intervention. To evaluate the effect of intervention at the post-test measures, Univariate Analyses of Covariance was performed whereby the pre-test score and variables on which the groups differed were considered as covariates. Standardized mean difference statistics of Cohen’s d was used to calculate the effect size, and the cut-off point for the level of significance was set at two-sided, p-value < 0.05.ResultsResults shows that the immediate post-test sexual health communication, motivation and behavioral skills scores were statistically significantly higher in the experimental group compared to control group (p < 0.05). Moreover, sexual health communication score after 6 months and at 1 year were statistically significantly higher in the experimental group compared to control group (p < 0.05). Information construct however did not differ between groups in post-test measures. Furthermore, results revealed that communication practice is statistically significantly associated with information, motivation and behavioural skills in post-test measures.ConclusionThe findings provided preliminary evidence for the effectiveness of SRH communication intervention and supported the significance of IMB model-constructs to inform the SRH-communication intervention and to guide the intervention evaluation.

A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain

Chagas disease (CHD) has become a challenge in Spain due to the high prevalence of immigrants coming from endemic areas. One of the main difficulties for its control and elimination is its underdiagnosis. The identification and integral treatment of CHD are key to increasing rates of diagnosis, overcoming psycho-social barriers and avoiding CHD progression. Community interventions with in situ screening have proven to be a useful tool in detecting CHD among those with difficulties accessing health services. To determine the underdiagnosis rate of the population most susceptible to CHD among those attending two different Bolivian cultural events celebrated in Barcelona; to describe the sociodemographic characteristics of the people screened; and to analyse the results of the screening. The community interventions were carried out at two Bolivian cultural events held in Barcelona in 2017. Participants were recruited through community health agents. A questionnaire was given to determine the participants' prior knowledge of CHD. In situ screening was offered to those who had not previously been screened. Those who did not wish to be screened were asked for the reason behind their decision. Results were gathered in a database and statistical analyses were performed using STATA v14. 635 interviews were carried out. 95% of the subjects reported prior knowledge of CHD. 271 subjects were screened: 71.2% women and 28.8% men, of whom 87.8% were of Bolivian origin. The prevalence of CHD was 8.9%. Community health interventions with in situ screening are essential to facilitating access to diagnosis.

Perceived Patient-Provider Communication Quality and Sociodemographic Factors Associated With Watching Health-Related Videos on YouTube: A Cross-Sectional Analysis.

BackgroundApproximately 73% of US adults use YouTube, making it the most popular social media platform. Misinformation on social media is a growing concern; recent studies show a high proportion of misinformative health-related videos. Several studies on patient-provider communication and general health information seeking have been conducted. However, few studies to date have examined the potential association between patient-provider communication and health information seeking on specific social media platforms such as YouTube. A better understanding of this relationship may inform future health communication interventions.ObjectiveThe aim was to use nationally representative cross-sectional data to describe the association between perceived patient-provider communication quality and sociodemographic factors on watching YouTube health-related videos.MethodsData from the 2018 Health Information National Trends Survey were analyzed (N=3504). The primary outcome was whether participants watched a health-related video on YouTube over the past 12 months. A patient-provider communication composite score was created by summing responses about how often providers did the following: (1) gave you the chance to ask all the health-related questions you had, (2) gave attention to your feelings, (3) involved you in health care decisions as much as you wanted, (4) made sure that you understood the things you needed to do to take care of your health, (5) explained things in a way that you could understand, (6) spent enough time with you, and (7) helped you deal with feelings of uncertainty. Sociodemographic factors included age, gender, race/ethnicity, and education. Descriptive statistics and multivariable logistic regression were conducted.ResultsApproximately 1067 (35% weighted prevalence) participants reported watching a health-related video on YouTube. Higher perceived quality of patient-provider communication on the composite score was significantly associated with lower odds of watching health-related videos on YouTube. Regarding sociodemographic factors, increasing age and being a high school graduate (compared with college graduate) were associated with lower odds of watching health-related videos on YouTube; whereas, Hispanic and non-Hispanic Asians were more likely to have watched a health-related video on YouTube. For individual aspects of patient-physician communication, two of seven patient-provider communication variables were significant. Those who reported that providers “sometimes” spent enough time with them had higher odds of watching a health-related video on YouTube, compared with those who said providers “always” spent enough time with them. Participants reporting that they “never” have a chance to ask all their health-related questions also had higher odds of watching health-related videos on YouTube compared with those who reported “always.”ConclusionsHigher perceived quality of patient-provider communication is associated with lower odds of watching health-related videos on YouTube. When providers do not spend enough time or give an opportunity to ask questions, patients are more likely to pursue health information on social media.

The Making of an Addiction: Examining Psychological Determinants of Prescription Stimulant Abuse among College Students

ABSTRACT Diagnoses of attention-deficit-disorders and stimulant prescriptions to treat these disorders (e.g., Adderall) are on the rise. The non-medical use of such stimulants (NUPS) as ‘study drugs’ has increased among college students, which aggravates the worsening prescription drug crisis in the U.S. This research examined the underlying psychological determinants of NUPS in order to inform effective health communication intervention efforts. It also tested potential individual-level characteristics that could influence such determinants in order to determine at-risk groups. This research utilized the reasoned action framework in a mixed-methods, two-study approach. Study 1 explored the underlying beliefs associated with intentions to engage in NUPS in an open-ended belief elicitation survey (N = 121), study 2 (N = 312) tested the psychological determinants of intentions and influencing individual-level characteristics in a quantitative survey. Results revealed (1) the top three unique attitudinal, normative, and control beliefs about NUPS; (2) instrumental attitude as strongest determinant of NUPS; (3) expectations of improved productivity, approval from friends and peers, access and financial means, peer pressure, and health risks as effective targets for effective health communication interventions; and (4) poor mental health, high levels of stress, and characteristics of perfectionism and sensation-seeking as aggravating risk factors among college students. Further implications and directions are discussed.

Participation as Inclusion and Exclusion: Policing the Boundaries of “Citizenship” in Roma Health Mediation

Participatory health interventions have long been advocated as an approach to help marginalised community members exercise their rights as citizens, including access to health care. More than two decades ago, the Roma health mediation programme was established in Romania as a participatory community health intervention. Mediators are employed specifically to act as intermediaries between ‘Roma patients’ and local authorities or health professionals, with the overall aim to increase trust and improve access to health care. Based on data gathered during a year of ethnographic fieldwork with Roma health mediators in Romania, including participant observation and interviews, this article analyses the social processes by which participatory approaches produce both social inclusion and exclusion. It illustrates how mediators exceeded their remit of health and attempted to discipline communities into forms of neoliberal citizenship. Mediators reframed access to health care not as a right that community members already have, but as a benefit that must be individually ‘earned’ through the fulfilment of neoliberal citizenship. The article argues that far from being an ‘empowering tool’, community participation can extend the power of governing institutions and thereby may in fact contribute to the maintenance of a political status quo that perpetuates the precarisation of marginalised communities.

Awareness, attitudes, and beliefs about music-induced hearing loss: Towards the development of a health communication strategy to promote safe listening

Objective: Worldwide, 1.1 billion young people are at risk of developing hearing loss due to unsafe listening. The World Health Organization plans a global health campaign to promote behavior change. In an effort to develop effective evidence-based interventions, this study identifies modifiable factors that influence listening habits.Methods: Online survey among 1019 individuals aged 18–35. The questionnaire was based on theories of behavior change.Results: Individuals not contemplating change showed a lack of knowledge, tended not to feel particularly at risk, and did not see the benefits of preventive measures. Conversely, those considering a change perceived more barriers (e.g., lack of information on how to act,). Self-efficacy was shown to play an ambivalent role.Conclusion: Four factors that can be influenced by a health communication intervention were identified: risk perception, perceived safe listening level due to a lack of symptoms, knowledge, and perceived benefits and barriers, in particular perceived loss of pleasure.Practice implications: The first aspects can be influenced through health communication interventions. Influencing the perceived loss of pleasure additionally requires an analysis of competing pressures. To support and not exceedingly burden the individual, we further suggest to address environmental aspects (e.g., policies).

The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature.

Food insecurity is a major public health concern characterized by an individual or household lacking access to adequate food to support a healthy lifestyle. Food insecurity has been associated with predisposing or exacerbating mental health symptoms in children. However, the evidence is scarce with regards to Attention-Deficit Hyperactivity Disorder (ADHD) symptoms in children. The purpose of this review is to summarize and identify gaps in the existing literature, as well as to explore associations between food insecurity and symptoms of childhood ADHD. Literature for this review was pulled from Ovid MEDLINE and PubMed library databases, with a focus on food insecurity, food insufficiency, hunger, and ADHD symptoms such as inattention, hyperactivity, and impulsivity in children. The limited evidence to date shows a predictive and inverse relationship between childhood experience of food insecurity and symptoms of ADHD, with lasting impacts into adulthood. Evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children, yet the literature needed to confirm this relationship is scarce and utilizes inconsistent methodology. Future research is needed to further characterize this complex relationship and inspire community or public health interventions addressing food insecurity in children with ADHD. Additionally, it may be clinically useful to routinely screen for food insecurity when assessing pediatric ADHD symptoms.

A conceptual model for establishing collaborative partnerships between universities and Native American communities.

Collaborative partnerships are increasingly recognised as valuable and essential tools for improving community health. To present the process used to establish a collaboration between a university and a community, including a description of the conceptual model that provided guidance for one such project. While numerous studies explore the potential benefits of such efforts, few have addressed how to initiate partnerships. The initiation phase and formative work required are arguably the most crucial step, as they become the foundation on which all future efforts are built and through which sustainability is achieved. These formative steps are essential when working with Native American communities, which experience severe health disparities, but for which limited initiatives are available for community health interventions. The approach used in this project can guide the establishment of a university-community collaboration, from initiation to evaluation.

Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System - United States, 2014-2017.

Drug overdose is the leading cause of unintentional injury-associated death in the United States. Among 70,237 fatal drug overdoses in 2017, prescription opioids were involved in 17,029 (24.2%) (1). Higher rates of opioid-related deaths have been recorded in nonmetropolitan (rural) areas (2). In 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates.* Higher opioid prescribing rates put patients at risk for addiction and overdose (3). Using deidentified data from the Athenahealth electronic health record (EHR) system, opioid prescribing rates among 31,422 primary care providers† in the United States were analyzed to evaluate trends from January 2014 to March 2017. This analysis assessed how prescribing practices varied among six urban-rural classification categories of counties, before and after the March 2016 release of CDC's Guideline for Prescribing Opioids for Chronic Pain (Guideline) (4). Patients in noncore (the most rural) counties had an 87% higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period. Across all six county groups, the odds of receiving an opioid prescription decreased significantly after March 2016. This decrease followed a flat trend during the preceding period in micropolitan and large central metropolitan county groups; in contrast, the decrease continued previous downward trends in the other four county groups. Data from EHRs can effectively supplement traditional surveillance methods for monitoring trends in opioid prescribing and other areas of public health importance, with minimal lag time under ideal conditions. As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics.

A Public Health Communication Intervention Using Edutainment and Communication Technology to Promote Safer Sex among Heterosexual Men Patronizing Entertainment Establishments

It is a challenge to reach out, develop and implement a communication intervention for heterosexual men (HSM) patronizing entertainment establishments (EEs) to promote safer sex. We described the theoretical basis and process from assessment to implementation where edutainment (talk shows) and communication technology (interactive web portal) was implemented. A female comedian hosted the talk shows. The portal contained an HIV risk profile calculator with individually tailored strategies to lower risk; two videos on real-life stories of unsafe sex and exit strategies to avoid casual or paid sex; as well as online support. We integrated edutainment, social cognitive theory (SCT) and the elaboration likelihood model (ELM). Edutainment techniques like humor through jokes, fun through games, and narrative persuasion through real-life accounts were applied. The SCT focused on modifying attitudes and social norm on sexual well-being, increasing self-perceived HIV/STI risk as well as building self-efficacy and skills in condom use. We applied the ELM to guide communication strategies and message development. For peripheral processing, we used cues like comedian delivery and charisma. For central processing, we focused on argument framing, issue involvement, argument quality, and modeling. The intervention was effective in promoting condom use with casual partners among the target group in Singapore.

Data Analysis and Synthesis Within a Realist Evaluation: Toward More Transparent Methodological Approaches

Realist evaluations are increasingly used in the study of complex health interventions. The methodological procedures applied within realist evaluations however are often inexplicit, prompting scholars to call for increased transparency and more detailed description within realist studies. This publication details the data analysis and synthesis process used within two realist evaluation studies of community health interventions taking place across Uganda, Tanzania, and Kenya. Using data from several case studies across all three countries and the data analysis software NVivo, we describe in detail how data were analyzed and subsequently synthesized to refine middle-range theories. We conclude by discussing the strengths and weaknesses of the approach taken, providing novel methodological recommendations. The aim of providing this detailed descriptive account of the analysis and synthesis in these two studies is to promote transparency and contribute to the advancement of realist evaluation methodologies.

The argument from example in health communication

Abstract The argument from example is frequently used in health communication interventions. Some of these arguments are narrative in nature, in the sense that they relate a series of logically related events containing an experiencing agonist. In this article, research on narrative persuasion is discussed in order to show how such narrative arguments from examples can influence the target audience’s beliefs about the possibility that a certain action will lead to certain consequences, the desirability of such consequences, as well as provide the target audience with ways by which to circumvent obstacles that prevent them from putting their intentions into actions. As such, narrative arguments from example can serve the needs of both people who still need to be motivated to change their behavior as those of people who already intend to adapt their behavior but fail to put this intention into action.

Decoloniality as a Framework for Indigenous Youth Suicide Prevention Pedagogy: Promoting Community Conversations About Research to End Suicide.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert-driven approaches to emphasize local control through processes that utilize research evidence, but privilege self- determined action based on local and personal contexts, meanings, and frameworks for action. "Promoting Community Conversations About Research to End Suicide" is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health-promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

What Drives Young Vietnamese to Use Mobile Health Innovations? Implications for Health Communication and Behavioral Interventions.

BackgroundMobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents.ObjectiveThis study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth.MethodsAn online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders.ResultsAmong 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps.ConclusionsThis study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management.

The CHOICE Project: A Randomised Exploratory Pilot Trial Testing the Acceptability and Preliminary Efficacy of a Public Health Communication Intervention

Referral to palliative care frequently occurs late in the illness course, despite evidence to support the benefits of early integration. A systematic approach to community engagement is required. Narrative communication is increasingly understood as a promising way of promoting health behaviour change. However few empirical approaches have been developed and tested seeking to change attitudes or behaviours related to palliative care. To evaluate the acceptability (primary outcome), feasibility, and preliminary efficacy (secondary outcome) of narrative communication as a public health intervention to educate community about palliative care. Based on the MRC Framework for the development of complex interventions, a series of 2-minute visual educational stories were developed to address common misperceptions raised by earlier qualitative data. These were piloted with a community-based sample using a phase 2, online, computer-randomised controlled trial design involving six experimental (narrative) conditions. Descriptive statistics described the sample characteristics and intervention acceptability. A repeated measures analysis of covariance (ANCOVA) assessed preliminary change in attitude to palliative care (measured on a 10-point Likert scale) post intervention, controlling for baseline variables. Of 164 participants (median age 51, range 23-82; 75% female), 150 completed post-intervention data (92% completion rate), with a mean completion time of 14.5 minutes. Visual educational stories were shown to be an acceptable approach to public health communication about palliative care, with respondents reporting a median of 7 positive ratings (IQR 6, 9) out of the 10 acceptability items. A majority of participants reported the intervention was easy to understand (100%), believable (93%), and made them feel more likely to likely to consider palliative care if they became seriously ill (68%) or talk to someone else about palliative care (65%). Most agreed it taught them something new (68%) and make them stop and think (59%). ANCOVA analyses showed a significant main effect, whereby regardless of narrative assignment, mean attitudes toward palliative care were improved after viewing the educational information (m 9.4, sd 1.0) compared to baseline (m 8.9, sd 1.6), F(1,132)=21.0, p< .001, np2 =.15 (large effect). This study provides novel pilot data addressing an important gap in the literature around the question of how to engage community about palliative care. Narrative communication is an acceptable public health intervention to communicate information about palliative care and may improve community attitudes to engagement with palliative care services.

Análisis del efecto de un programa de estimulación cognitiva en personas con envejecimiento normal en Atención Primaria: ensayo clínico aleatorizado

ObjectiveTo provide evidence of the effectiveness of a community health intervention, that includes a cognitive stimulation program, to prevent the deterioration of cognitive abilities in our population of elderly people with normal cognition that are living in the community. DesignRandomized clinical trial (CONSORT group norms) LocationSan José Norte-Centro Health Center and La Caridad Foundation (Zaragoza, Spain). Participants201 people aged 65 or older, with a MEC score of at least 28 points, which were randomized between the Intervention group (101) and the Control group (100). InterventionThe intervention was applied in 10 sessions of 45minutes, one per week. It used materials designed by one of the authors, which addressed the following areas: memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention-concentration and programming. Main measurementsThe main outcome variables were MEC, Set-Test, Barthel and Lawton-Brody. ResultsIncreases of the main result variables over their baseline level were analized. For MEC variable, the Intervention group obtained, on average, 1.58 points more than the Control group in the evaluation performed immediately after the intervention. After 6months, the improvement was 1.51 points and after a year, it was of 2.04 points. All these differences were statistically significant. For Set-Test, Barthel and Lawton-Brody variables, no statistically significant differences were observed between Intervention group and Control group. ConclusionsCognitive stimulation with our program is effective to maintain or improve cognitive performance, measured with the variable MEC, our population of elderly people with normal cognition that are living in the community. There is no evidence that this improvement is transferred to the activities of daily life measured with Barthel and Lawton-Brody variables.

A health communication intervention to integrate partner testing with antiretroviral therapy service among men who have sex with men in China: an observational cohort study

BackgroundIn China, antiretroviral therapy (ART) clinics focus on treating people living with HIV and are not required to undertake testing of high-risk populations. To improve partner testing among MSM, we implemented a health communication pilot intervention integrating partner testing with ART services. We aimed to assess the feasibility of the partner referral service and identify the predictors of both successful partner referral for HIV testing and HIV-positive test results among referred partners.MethodsThis program ran from April 2014 through December 2015 at designated ART clinics in six cities. The index participants, men living with HIV enrolled at an ART clinic, were assigned a case manager who assumed responsibility for routine ART-related counseling and mobilization of HIV-positive index participants for partner referral testing. Case managers were either nurses or contract staff. The successful referral rate was the proportion of index participants who referred a sexual partner for HIV testing. The HIV-positive partner rate was the proportion of the newly referred contacts who tested HIV-positive. Factors associated with the successful referral rate and the HIV-positive partner rate were assessed.ResultsTwo thousand three hundred eighty-two index participants were enrolled. The median age was 30 years (IQR 26–37). 829index participants (34.80%) successfully referred at least one sexual partner for screening, and 92 (11.10%) referred partners were HIV-positive. Having a hospital nurse as case manager was associated with both successful partner referral (AHR = 1.56, 95% CI = 1.36–1.80) and having a HIV-positive partner (AHR = 2.35, 95% CI = 1.45–3.92). Index participants who were married (AHR = 1.44, 95% CI = 1.20–1.73) or employed (AHR = 1.29, 95% CI = 1.11–1.49) were more likely to successfully refer a partner for testing. Stable male partner relations were more likely to result in a referred partner testing HIV-positive (AHR = 5.50, 95% CI = 1.85–16.39).ConclusionOur findings indicated that integration of MSM partner testing with ART services via health communication was feasible. Nurses as case managers effectively encouraged index participants to refer their sexual partners for HIV testing.