Context Of Treatment Research Articles

Capturing the context of drug use for college students: A Contextual Behavioural Science informed qualitative Analysis of Harm reduction practices using network feedback loops simulation modelling

Drug use during college can have substantial harm on students’ lives and impacts the institutions’ functioning and local communities. Yet existing interventions for drug use at college poorly address the concurrent dynamic influences of the experiences in earlier developmental periods of young adults and the proximal contextual triggers of college life; both risk factors that contribute to drug use. In answer to this, system dynamic methods and contextual-behavioural science (CBS) approaches can support the development of interventions to address these risk factors. Using Causal Loop Diagram methods (Vensim PLE), we collected qualitative data from college students (n=24, aged 22 years old), during the development phase of MyUse: a contextual behavioural change intervention for harm reduction practices at college students, to generate Network Feedback Loops (NFLs). The findings underscore central nodes (determinants within an intervention) that can support our previous identified three CBS-harm-reduction practices for college students (targeted edges: mindful drug-use decision making, value-based activities, context-sensitive personalized plan of harm reduction). Analyses revealed 4 NFLs for students with previous drug use, consisting of 13 edges (4 positive, 2 negative, and 4 balancing reinforcing relationships) and 3 NFLs for students with no previous drug use, consisting of 4 positives, one negative, and one balancing relationship. All these determinants (manipulable variables) are nested with the three CBS-related targeted outcomes. College students who use drugs need drug-related knowledge about the unpredictable and adverse effects of drugs, presented in a compassionate way and distributed from credible resources (e.g., students’ unions/ club). Students with no previous drug use need education about the effects of drugs and awareness of how drugs can devaluate value-based activities (e.g. sports, friendships, social life). These should be delivered via proxy cue reminders and mobile-text-messages conveying drug use susceptibility, distributed in real-time. Idiosyncratic, dynamic, and contextual-bound factors of lapse risks or preventive practices should account for each person-specific vulnerabilities via personalized harm reduction plans.

Exploring the contextual assumptions, interventions and outcomes of digital advance care planning systems: A theory of change approach to understand implementation and evaluation

Exploring the contextual assumptions, interventions and outcomes of digital advance care planning systems: A theory of change approach to understand implementation and evaluation

A conceptual framework to improve the quality of life in patients with CKD on dialysis in KwaZulu Natal Province, South Africa

Chronic kidney disease (CKD) is one non-communicable disease mainly caused by comorbid of diabetes and hypertension, thus compromising quality of life for the patients. Few rigorous Quality of Life frameworks on chronic kidney disease (CKD) have been reported in low-middle income countries including South Africa. Therefore, the study aimed at developing a Conceptual Framework to improve the Quality of Life in Patients with CKD on Dialysis in KwaZulu Natal Province, South Africa. A Mixed method sequential explanatory design which entails collection of quantitative data, followed by qualitative. A purposive sampling of 316 CKD patients for quantitative was initially selected. For qualitative, 17 healthcare professionals were theoretically sampled until data saturation. A structured questionnaire (WHO HRQOL–BREF) was utilized to collect numerical data for quantitative phase, while focus group discussions provided qualitative insights. The quantitative results indicated low quality of life (QoL) in several dimensions: economic (98 %), psychological (95 %), physical (70 %), and social (55 %). Grounded theory analysis of the qualitative data identified key predictors of QoL as the patients' geographic location, accessibility to haemodialysis centres, their ability to adapt and accept the condition, self-management practices, support from family members and caregivers including the presence of well-trained nursing staff.A comprehensive conceptual framework was developed through identifying contextual factors, interventions and outcomes that is expected to improve the QOL. The study recommends the immediate intervention of the policy makers and health care providers in drafting and implementing policies to improve the QOL in patients with CKD.

A Cross-Sectional Study of Spanish Grindr Users: Sociodemographic Characteristics, Sexual Health Trends, and Attitudes toward HIV Testing.

Men who have sex with men are at an increased risk of acquiring sexually transmitted infections, and although behavioral and contextual interventions have improved, infections continue to spread. Therefore, a new focus on recent trends in sexual health in this population is needed. The aim of this study was to describe the relationship between sociodemographic and behavioral characteristics according to Grindr usage patterns, the prevalence of sexually transmitted infections (STIs), and attitudes toward HIV testing. In January 2020, a cross-sectional study was conducted using a sample of 881 men who have sex with men (MSM) who completed an online questionnaire. We evaluated their Grindr use patterns (moderate or intensive) and explored the associations of these with sociodemographic behavioral characteristics, STIs, and attitudes toward HIV testing. Of 881 participants in total, 587 (66.6%) were intensive Grindr users. Compared to moderate users, these participants reported significantly higher numbers of casual sexual partners (76.2% vs. 23.8%; p < 0.001), were more likely to participate in Chemsex (77.3% vs. 22.7%: p = 0.031), and had a higher self-reported number of STIs (69.9% vs. 30.1; p = 0.046). They also demonstrated better attitudes toward HIV testing (69.7% vs. 30.3%; p = 0.045) and perceived themselves to be at moderate risk of HIV (71.2% vs. 28.8%: p = 0.048). Moreover, intensive Grindr users were 1.36 times more likely than moderate users to test positive for STIs (95%CI = 1.15-1.91; p = 0.048). With some limitations, age, sexual partners, intensive Grindr users, and PrEP uses were associated with the risk of STIs in the sample of Spanish Grindr users studied. As Grindr users are vulnerable to sociodemographic and behavioral factors that determine STIs and HIV infection, mainly among intensive users, it is necessary to highlight the importance of new trends such as online dating apps, PrEP use, substance use in sex, and Chemsex, and these need to be incorporated into online public health strategies.

Within-person and between-person associations of access to environmental reward with alcohol and cannabis use and consequences among young adults

BackgroundRecent behavioural economic models of substance use suggest that low access to environmental reward may increase risk for heavy substance use and associated harms. Most prior studies of these associations have been cross-sectional and have focused on alcohol. The current study extends this research using longitudinal data to examine the within-person and between-person associations of environmental reward access with both alcohol and cannabis outcomes. MethodYoung adults (N = 119, 64.71 % female) completed an online survey at three time points, spaced six months apart. The survey included measures of alcohol and cannabis use and consequences, and two facets of environmental reward access: reward probability (i.e., likelihood of experiencing environmental reward) and environmental suppression (i.e., diminished availability of environmental reward). ResultsMultilevel models revealed that at the between-person level (i.e., averaged across time points), greater environmental suppression (but not reward probability) was significantly associated with more frequent cannabis use, and greater reward probability (but not environmental suppression) was significantly associated with heavier alcohol use. Higher environmental suppression (but not reward probability) was also associated with greater alcohol and cannabis consequences at the between-person level, over and above level of use. A significant within-person association also was observed, wherein participants reported relative increases in cannabis consequences during time periods when they also reported relative decreases in the availability of environmental reward. ConclusionsResults highlight environmental suppression as a risk factor for more frequent cannabis use and for both alcohol and cannabis consequences, and provide novel support for a within-person association between environmental suppression and cannabis consequences over time. Findings may inform contextual interventions for young adult substance use.

Implementation fidelity of intravenous ferric carboxymaltose administration for iron deficiency anaemia in pregnancy: a mixed-methods study nested in a clinical trial in Nigeria

BackgroundIron deficiency anaemia is common among pregnant women in Nigeria. The standard treatment is oral iron therapy, which can be sub-optimal due to side effects. Intravenous ferric carboxymaltose (FCM) is an evidenced-based alternative treatment with a more favourable side effect profile requiring administration according to a standardized protocol. In this study, we assessed the fidelity of administering a single dose of FCM according to protocol and identified factors influencing implementation fidelity.MethodsWe used a mixed-method approach with a sequential explanatory design nested in a clinical trial across 11 facilities in Lagos and Kano States, Nigeria. Guided by a conceptual framework of implementation fidelity, we quantitatively assessed adherence to protocol by directly observing every alternate FCM administration, using an intervention procedure checklist, and compared median adherence by facility and state. Qualitative fidelity assessment was conducted via in-depth interviews with 14 skilled health personnel (SHP) from nine purposively selected health facilities, using a semi-structured interview guide. We analyzed quantitative data using descriptive and inferential statistics in Stata and used thematic analysis to analyze the transcribed interviews in NVivo.ResultsA total of 254 FCM administrations were observed across the 11 study sites, with the majority in secondary (63%), followed by primary healthcare facilities (PHCs) (30%). Overall, adherence to FCM administration as per protocol was moderate (63%) and varied depending on facility level. The lowest level of adherence was observed in PHCs (36%). Median, adherence level showed significant differences by facility level (p = 0.001) but not by state (p = 0.889). Teamwork and availability of protocols are facilitation strategies that contributed to high fidelity. However, institutional/ logistical barriers are contextual factors that influenced the varied fidelity levels observed in some facilities.ConclusionsCollaborative teams and access to operating protocols resulted in high fidelity in some facilities. However, in some PHCs, fidelity to FCM was low due to contextual factors and intervention complexities, thereby influencing the quality of delivery. In Nigeria, scale-up of FCM will require attention to staff strength, teamwork and availability of administration protocols, in order to optimize its impact on anaemia in pregnancy.

An implementation manual for an interprofessional enhanced recovery after surgery protocol in cardiac surgery following international established frameworks.

Enhanced Recovery After Surgery (ERAS) protocols represent a paradigm shift in perioperative care, aim to optimize patient outcomes and accelerate recovery. This manual presents findings from implementing the INCREASE study, a bicentric prospective randomized controlled trial focusing on ERAS in minimally invasive heart valve surgery. Utilizing the Consolidated Framework for Implementation Research (CFIR) and the Template for Intervention Description and Replication (TIDieR), the study examined contextual factors, intervention components, and implementation strategies. Key findings from the CFIR analysis revealed critical domains influencing implementation success. These included innovation characteristics, external and internal settings, and individual dynamics. The study showcased ERAS's adaptability to diverse healthcare systems, emphasizing its potential for successful integration across varying contexts. Furthermore, the importance of interprofessional collaboration emerged as a foundation of practical implementation, fostering teamwork, communication, and patient-centered care. Utilizing the TIDieR framework, this manual comprehensively describes ERAS intervention components, detailing preoperative counseling, intraoperative management, and postoperative care strategies. The manual underscored the importance of tailored, patient-centered approaches, highlighting the role of an academic ERAS nurse, early mobilization, and psychosomatic interventions in promoting optimal recovery outcomes. In conclusion, the INCREASE study provided valuable insights for creating an implementation manual for ERAS in cardiac surgery, emphasizing adaptability, collaboration, and ongoing evaluation as key drivers of successful implementation. These findings have broad implications for improving patient care outcomes and advancing perioperative practices in cardiac surgery settings.

Rural development opportunities through contextual interventions: a systematic review

Rural development opportunities through contextual interventions: a systematic review

Meningkatkan Kemampuan Berpikir Kritis Anak Usia Dini melalui Pembelajaran Sains Kontekstual di RA Al-Hidayah

The capacity to assess arguments, examine data, and draw logical conclusions is known as critical thinking. Contextual learning is a technique to learning that works well for scientific education. The goal of the research was to enhance the critical thinking skills of young children at RA Al-Hidayah through contextual scientific instruction, as their critical thinking abilities are still poor. A classroom action research (PTK) design utilizing the Kemmis and McTaggart spiral model is employed in this study. Descriptive qualitative data analysis is the method employed. Group B is the early childhood research subjects. Ten kids served as the research subjects. Worksheets, interview instructions, and observation sheets were the equipment utilized in this study. The study's findings demonstrate how well this intervention works to help young children develop their critical thinking skills. According to this study, contextual scientific learning interventions have been shown to be successful in raising young children's critical thinking abilities across the board.

Sexual Compulsivity and Gender Stereotypes in Men Who Have Sex with Men: A Cross-Sectional Study in Spain

Men who have sex with men are at increased risk of acquiring sexually transmitted infections. Although behavioral and contextual interventions have improved, infections are still spreading. A new focus is needed regarding the influence of sexual compulsivity and gender self-identification. The objective was to explore the relationship between SC and gender stereotype self-identification in MSM in Spain. A cross-sectional study based on an anonymous online survey of a sample of 881 MSM in Spain was performed. A validated Sexual Compulsivity Scale was applied as well as the Bem Sex Role Inventory to identify gender stereotype self-identification. A total of 87.5% of participants identified as gay, while 106 (12%) were sexually compulsive. The Bem Sex Role Inventory showed excellent reliability (0.92 Cronbach’s alpha). Gender stereotype classification showed the undifferentiated category as predominant (n = 325; 36.9%). The androgynous category had higher scores on the Sexual Compulsivity Scale, while the feminine category had lower scores (p &lt; 0.007). Those identifying as androgynous scored higher overall on the Sexual Compulsivity Scale (15; p &lt; 0.001; [12–20]) and subscales (“Interference of sexual behavior” (5; p &lt; 0.001; [4–7]) and “Failure to control sexual impulses” (9; p = 0.014; [7–12])). Education level, cohabitation, sexual role, and unprotected sexual practices are related to sexual compulsivity according to different gender stereotypes. Sexual compulsivity is related to gender stereotype self-identification in men who have sex with men. Specific sociodemographic, behavior, and sexual profiles exist for those at greater risk of sexually transmitted infection dissemination. The undifferentiated category is at greater risk of engaging in unprotected practices. New avenues of prevention that include these findings could shift heteronormative standards to better understand current trends in the sexual health of men who have sex with men.

Improving foot self-care in people with diabetes in Ghana: A development and feasibility randomised trial of a context appropriate, family-orientated diabetic footcare intervention.

Africa presents a higher diabetic foot ulcer prevalence estimate of 7.2% against global figures of 6.3%. Engaging family members in self-care education interventions has been shown to be effective at preventing diabetes-related foot ulcers. This study culturally adapted and tested the feasibility and acceptability of an evidence-based footcare family intervention in Ghana. The initial phase of the study involved stakeholder engagement, comprising Patient Public Involvement activities and interviews with key informant nurses and people with diabetes (N = 15). In the second phase, adults at risk of diabetes-related foot ulcers and nominated caregivers (N = 50 dyads) participated in an individually randomised feasibility trial of the adapted intervention (N = 25) compared to usual care (N = 25). The study aimed to assess feasibility outcomes and to identify efficacy signals on clinical outcomes at 12 weeks post randomisation. Patient reported outcomes were foot care behaviour, foot self-care efficacy, diabetes knowledge and caregiver diabetes distress. Adjustments were made to the evidence-based intervention to reflect the literacy, information needs and preferences of stakeholders and to develop a context appropriate diabetic foot self-care intervention. A feasibility trial was then conducted which met all recruitment, retention, data quality and randomisation progression criteria. At 12 weeks post randomisation, efficacy signals favoured the intervention group on improved footcare behaviour, foot self-care efficacy, diabetes knowledge and reduced diabetes distress. Future implementation issues to consider include the staff resources needed to deliver the intervention, family members availability to attend in-person sessions and consideration of remote intervention delivery. A contextual family-oriented foot self-care education intervention is feasible, acceptable, and may improve knowledge and self-care with the potential to decrease diabetes-related complications. The education intervention is a strategic approach to improving diabetes care and prevention of foot disease, especially in settings with limited diabetes care resources. Future research will investigate the possibility of remote delivery to better meet patient and staff needs. Pan African Clinical Trials Registry (PACTR) - PACTR202201708421484: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=19363 or pactr.samrc.ac.za/Search.aspx.

Protocol for process evaluation of ARTEMIS cluster randomised controlled trial: an intervention for management of depression and suicide among adolescents living in slums in India

IntroductionThere are around 250 million adolescents (10–19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those...

Uncovering the determinants of brain functioning, behavior and their interplay in the light of context.

Notwithstanding the huge progress in molecular and cellular neuroscience, our ability to understand the brain and develop effective treatments promoting mental health is still limited. This can be partially ascribed to the reductionist, deterministic and mechanistic approaches in neuroscience that struggle with the complexity of the central nervous system. Here, I introduce the Context theory of constrained systems proposing a novel role of contextual factors and genetic, molecular and neural substrates in determining brain functioning and behavior. This theory entails key conceptual implications. First, context is the main driver of behavior and mental states. Second, substrates, from genes to brain areas, have no direct causal link to complex behavioral responses as they can be combined in multiple ways to produce the same response and different responses can impinge on the same substrates. Third, context and biological substrates play distinct roles in determining behavior: context drives behavior, substrates constrain the behavioral repertoire that can be implemented. Fourth, since behavior is the interface between the central nervous system and the environment, it is a privileged level of control and orchestration of brain functioning. Such implications are illustrated through the Kitchen metaphor of the brain. This theoretical framework calls for the revision of key concepts in neuroscience and psychiatry, including causality, specificity and individuality. Moreover, at the clinical level, it proposes treatments inducing behavioral changes through contextual interventions as having the highest impact to reorganize the complexity of the human mind and to achieve a long-lasting improvement in mental health.

Developing a theory of change - the importance of rich process data and authors' insights into context, implementation and mechanisms.

Theories of change explaining how interventions work are increasingly important, yet the methods/data to develop these are less advanced than for evaluating effects. We conducted a systematic evidence synthesis to develop a theory of change for structural adolescent contraception interventions. We reflect on the utility of the information provided in evaluation reports. Few of the included evaluations presented their theory of change, or included rich, qualitative process data. Authors' descriptions of context and implementation, typically in introduction and discussion sections, were very useful. These helped to understand the intervention's context, how it was experienced and why or how it had the effect that it did. We recommend incorporating rich process evaluations into studies, and reporting contextual insights into the intervention's development, implementation and experience. We also recommend including these data and insights within syntheses that aim to develop theories of change.

A rapid review of opportunities and challenges in the implementation of social prescription interventions for addressing the unmet needs of individuals living with long-term chronic conditions

BackgroundPeople with long-term chronic conditions often struggle to access and navigate complex health and social services. Social prescription (SP) interventions, a patient-centred approach, help individuals identify their holistic needs and increase access to non-clinical resources, thus leading to improved health and well-being. This review explores existing SP interventions for people with long-term chronic conditions and identifies the opportunities and challenges of implementing them in primary healthcare settings.MethodsThis rapid review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and searched relevant articles in three databases (PubMed/MEDLINE, EMBASE, and Web of Science) by using subject headings and keywords combined with Boolean operators. The search encompassed articles published between January 2010 and June 2023. Two authors independently conducted study screening and data abstraction using predefined criteria. A descriptive synthesis process using content analysis was performed to summarise the literature.ResultsFifteen studies were included, with all but one conducted in the United Kingdom, and revealed that social prescribers help guide patients with long-term chronic conditions to various local initiatives related to health and social needs. Effective implementation of SP interventions relies on building strong relationships between social prescribers and patients, characterised by trust, empathy, and effective communication. A holistic approach to addressing the unmet needs of people with long-term chronic conditions, digital technology utilisation, competent social prescribers, collaborative healthcare partnerships, clinical leadership, and access to local resources are all vital components of successful SP intervention. However, the implementation of SP interventions faces numerous challenges, including accessibility and utilisation barriers, communication gaps, staffing issues, an unsupportive work environment, inadequate training, lack of awareness, time management struggles, coordination and collaboration difficulties, and resource constraints.ConclusionThe present review emphasises the importance of addressing the holistic needs of people with long-term chronic conditions through collaboration and coordination, training of social prescribers, community connections, availability of local resources, and primary care leadership to ensure successful interventions, ultimately leading to improved patient health and well-being outcomes. This study calls for the need to develop or utilise appropriate tools that can capture people's holistic needs, as well as an implementation framework to guide future contextual SP interventions.

Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation

BackgroundGlobally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project’s impact.MethodsA pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to ‘standard’ state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine.DiscussionDefining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized ‘access to family planning’ based on a composite of beliefs about using services if needed.Trial registrationISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.

Time perspectives and procrastination in university students: exploring the moderating role of basic psychological need satisfaction

BackgroundResearch on procrastination, regarding time perspective factors and basic psychological need satisfaction (BPNS) has placed this problem at the meeting point of individual and contextual variables. The present study focused both on the individual, given that time perspectives can be defined as a person’s attitude to an object (time) at three moments (present, past, future); and on contextual aspects, because the satisfaction of basic psychological needs (competence, autonomy, relatedness) is facilitated or made difficult by social contexts. Based on this, the aim of this study was to analyse the relationships between time perspectives and inter-subject procrastination variations, testing the moderating role of BPNS in this relationship.MethodA total of 1,188 undergraduate students, aged 17–50 years (M = 20.02, SD = 2.63), completed three questionnaires containing the variables of interest.ResultsRegression analyses showed significant negative (thus, potentially protective) association of future time perspective with all three procrastination dimensions (decisional procrastination, implemental delay, and lateness). Conversely, past-negative time perspective showed a positive (thus, potentially adverse) association with procrastination. Satisfaction of the need for competence also showed a negative (thus, potentially protective) association with all procrastination dimensions. On eight occasions, the relationships between time perspectives and procrastination dimensions were moderated by psychological need satisfaction.ConclusionsThese findings show that BPNS may play relevant roles in the negative (favourable) relationships between procrastination dimensions and positive time perspectives, as well as in the positive (adverse) associations between negative time perspectives and procrastination dimensions. Contextual interventions fostering enhanced levels of perceived autonomy, competence, and relatedness, as well as future time perspective, are thus strong candidates to consider for use and evaluation by policy makers, pedagogues, teachers, coaches and other professionals interested in counteracting procrastination tendencies.

Attitudes towards COVID-19 vaccination: A cross sectional study in the Federal Capital Territory, Nigeria.

Vaccine acceptance is complex and context-specific, varying across time, place and perceived behavioural nature of the community involved. A high vaccine acceptance rate is important to achieve herd immunity, however, vaccine hesitancy is a possible barrier to this. This study aimed to assess attitudes towards COVID-19 vaccination and associated factors. A cross-sectional survey was undertaken to investigate the attitudes of Federal Capital Territory residents towards COVID-19 vaccine uptake in Nigeria. Data were collected using questionnaires which were administered to respondents physically and online through random and snowball sampling strategies respectively. Data received were then analysed using Statistical Package for Social Sciences (SPSS). A total of 1767 responses were received with males representing 57.8% of the sample. More than half (54.9%) of the respondents were between the ages of 18-30 years. A third (35.4%) of the study participants indicated that a vaccine was not necessary for COVID-19, and 56.5% indicated willingness to accept COVID-19 vaccination. The majority of the sample (56.9%) indicated that the government decision-making was in their best interest, whilst close to two-thirds of the respondents (61%) were of the view that COVID-19 vaccination should not be made compulsory. Older respondents as represented by those over 60 years were more likely to accept COVID-19 vaccination (p = 0.039). This study however revealed negative attitudes towards COVID-19 vaccination, indicating the urgent need for government, policymakers, and other stakeholders to prioritise the development of strategies that can appropriately address vaccine hesitancy in the study setting. Contextual interventions indicated include strategic public enlightenment campaigns targeting populations with less favourable dispositions towards being vaccinated.

ELIFEwithIBD: study protocol for a randomized controlled trial of an online acceptance and commitment therapy and compassion-based intervention in inflammatory bowel disease.

Inflammatory bowel disease (IBD) entails physical, psychological, and social burden and holds a significant impact on quality of life. Experiential avoidance, cognitive fusion, shame, and self-criticism have been identified as possible therapeutic targets for improving mental health in people with IBD. Traditional face-to-face psychological therapy continues to provide obstacles for patients seeking assistance. Online psychological therapies centered on acceptance, mindfulness, and compassion have been shown to improve psychological distress in other populations. This paper presents the study protocol of a two-arm Randomized Controlled Trial (RCT) of an ACT and compassion-based, online intervention - eLIFEwithIBD - on the improvement of psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, and self-compassion. The eLIFEwithIBD intervention is an adaptation of the LIFEwithIBD programme (delivered through an in-person group format) and entails an ACT, mindfulness, and compassion-based intervention designed to be delivered as an e-health tool for people with IBD. This protocol outlines the structure and contents of the eLIFEwithIBD intervention. Participants were recruited by an advertisement on the social media platforms of Portuguese Associations for IBD in January 2022. A psychologist conducted a brief interview with 80 patients who were interested in participating. Fifty-five participants were selected and randomly assigned to one of two conditions [experimental group (eLIFEwithIBD + medical TAU; n = 37) or control group (medical TAU; n = 18)]. Outcome measurement took place at baseline, post-intervention, and 4-month follow-up. All analyses are planned as intent-to-treat (ITT). The eLIFEwithIBD intervention is expected to empower people with IBD by fostering psychological strategies that promote illness adjustment and well-being and prevent subsequent distress. The eLIFEwithIBD aims to gain a novel and better understanding of the role of online contextual behavioral interventions on improving the quality of life and mental health of people with IBD. https://classic.clinicaltrials.gov/ct2/show/NCT05405855, NCT05405855.

Towards Context-Aware Emotion Recognition Debiasing from a Causal Demystification Perspective via De-confounded Training.

Understanding emotions from diverse contexts has received widespread attention in computer vision communities. The core philosophy of Context-Aware Emotion Recognition (CAER) is to provide valuable semantic cues for recognizing the emotions of target persons by leveraging rich contextual information. Current approaches invariably focus on designing sophisticated structures to extract perceptually critical representations from contexts. Nevertheless, a long-neglected dilemma is that a severe context bias in existing datasets results in an unbalanced distribution of emotional states among different contexts, causing biased visual representation learning. From a causal demystification perspective, the harmful bias is identified as a confounder that misleads existing models to learn spurious correlations based on likelihood estimation, limiting the models' performance. To address the issue, we embrace causal inference to disentangle the models from the impact of such bias, and formulate the causalities among variables in the CAER task via a customized causal graph. Subsequently, we present a Contextual Causal Intervention Module (CCIM) to de-confound the confounder, which is built upon backdoor adjustment theory to facilitate seeking approximate causal effects during model training. As a plug-and-play component, CCIM can easily integrate with existing approaches and bring significant improvements. Systematic experiments on three datasets demonstrate the effectiveness of our CCIM.