Counseling Messages Research Articles

Pengaruh Penyuluhan dengan Media Audiovisual terhadap Kepatuhan Perilaku Konsumsi Tablet Besi pada Ibu Hamil di Desa Bangun Rejo Kabupaten Deli Serdang Provinsi Sumatera Utara Tahun 2024

Counseling with media can arouse and bring pregnant women into an atmosphere of joy and happiness, where there is emotional and mental involvement. The effectiveness of using counseling media is largely determined by the number of senses involved. The more senses used, the easier it is to understand the counseling message. This study aims to analyze the effect of counseling using audiovisual media on compliance with iron tablet consumption behavior in pregnant women in Bangun Rejo Village, Deli Serdang Regency, North Sumatra Province in 2024. This type of research is an intervention study using a true experimental research design. The design of this study is a pre-test and post-test with control group design. A pre-test was carried out, then an intervention was carried out on the experimental group and the control group, then a post-test was carried out on the experimental group and the control group with a time gap of two weeks. With a sample size of 32 pregnant women in the third trimester using the Wilcoxon test. The results showed an increase in compliance in the counseling group using audiovisual media was greater, namely 43.73 compared to the counseling group that did not use audiovisual media, namely 31.60. The data were then analyzed using an independent t-test with computer software and produced a p-value of 0.000 <0.05. Conclusion: Counseling using audiovisual media can increase compliance in consuming iron tablets compared to counseling alone without using media.

Pengaruh Pola Asuh Orang Tua dengan Perkembangan pada Balita Usia 1–3 Tahun di Desa Bangun Rejo Kabupaten Deli Serdang Provinsi Sumatera Utara Tahun 2024

Counseling with media can arouse and bring pregnant women into an atmosphere of joy and happiness, where there is emotional and mental involvement. The effectiveness of using counseling media is largely determined by the number of senses involved. The more senses used, the easier it is to understand the counseling message. This study aims to analyze the effect of counseling using audiovisual media on compliance with iron tablet consumption behavior in pregnant women in Bangun Rejo Village, Deli Serdang Regency, North Sumatra Province in 2024. This type of research is an intervention study using a true experimental research design. The design of this study is a pre-test and post-test with control group design. A pre-test was carried out, then an intervention was carried out on the experimental group and the control group, then a post-test was carried out on the experimental group and the control group with a time gap of two weeks. With a sample size of 32 pregnant women in the third trimester using the Wilcoxon test. The results showed an increase in compliance in the counseling group using audiovisual media was greater, namely 43.73 compared to the counseling group that did not use audiovisual media, namely 31.60. The data were then analyzed using an independent t-test with computer software and produced a p-value of 0.000 <0.05. Conclusion: Counseling using audiovisual media can increase compliance in consuming iron tablets compared to counseling alone without using media.

Effects of family planning counselling and media messages on contraceptives use by Nigerian men: Evidence from the Nigeria demographic and health survey.

Generally, man plays a more significant role in population health in developing countries like Nigeria, as most of them show no interest in contraceptive use. Hence, to achieve the desired population control in a developing country like Nigeria, men must step up the modern use of contraceptives. The objective of the study was to examine the effect of family planning counselling and media messages about reproductive health on men's acceptance of contraceptives. Precisely, the study sought to determine if the use of counselling and radio messages on family planning could enhance the acceptance of contraceptive usage among men in developing countries like Nigeria. The researchers sourced the data for the study from the Nigerian Demographic and Health Survey conducted in 2018 and used the Logit regression method for the data analysis. Results from the analysis showed that counselling at health facilities and radio messages on modern contraceptive use have positive and significant effects on men's acceptance of contraceptives. Based on the findings, the study recommended that the best way to increase contraceptive use among men in Nigeria and some other developing countries is to compel pregnant women attending antenatal care services to come with their husbands to the health facility once a month, during which the men could be counselled on the importance of modern contraceptives usage.

Addressing the growing burden of obesity, diabetes and asthma in children and adolescents: The role of primary health care and the WHO Pocket book in Europe for a healthy future

The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases.The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions.

Feasibility randomised controlled trial of face-to-face counselling and mobile phone messages compared to usual care for smokeless tobacco cessation in Indian primary care: Project CERTAIN.

Smokeless tobacco (SLT) use in low- and middle-income countries (LMICs) has adverse health consequences. We hypothesize that it is feasible to test an intervention of mobile phone messages and face-to-face counselling session for SLT cessation in India. We conducted an exploratory, individual parallel two group, randomised controlled trial (RCT), with baseline -and end-point (three months from randomisation) assessments in urban primary health centres in Odisha, India. A total of 250 current (i.e., users in the last three months) SLT users or dual users (i.e., smokers and SLT users) were recruited to the trial (125 in each group). Participants were randomised to either routine care, face-to-face counselling, and reminder mobile messages or routine care only. The primary outcomes were to assess the feasibility of running a full RCT including recruitment, compliance, and retention. A total seven (77.8%) out of nine primary care centres took part in the trial. Out of the 315 SLT users invited to participate, 250 provided consent and were randomised [79.4% (95% CI: 74.5, 83.7)]. Out of the 250 randomised SLT users, 238 [95% (95% CI: 91.8, 97.5)] were followed up at three months (117 in the intervention group and 121 in the control group). Of the participants in the intervention group, 74 (63.8%) reported that they received the mobile messages. This exploratory trial demonstrated the feasibility of delivering and evaluating an intervention of mobile phone messages and face-to-face counselling for SLT users in Indian primary care in a full randomised trial. This study found that combining mobile messages with face-to-face counselling for smokeless tobacco users visiting primary health care settings in India is feasible in terms of recruitment of users, compliance with the intervention, and retention of study participants within the trial.The biochemically verified smokeless tobacco abstinence rate was higher in the intervention group compared with the control groupThere was poor agreement between self-reported tobacco cessation and the measured salivary cotinine in smokeless tobacco users.The findings support the feasibility and acceptability of the intervention signalling the need for a larger clinical trial to test effectiveness of the intervention.

How PrEP delivery was integrated into public ART clinics in central Uganda: A qualitative analysis of implementation processes.

Tailored delivery strategies are important for optimizing the benefit and overall reach of PrEP in sub-Saharan Africa. An integrated approach of delivering time-limited PrEP in combination with ART to serodifferent couples encourages PrEP use in the HIV-negative partner as a bridge to sustained ART use. Although PrEP has been delivered in ART clinics for many years, the processes involved in integrating PrEP into ART services are not well understood. The Partners PrEP Program was a stepped-wedge cluster randomized trial of integrated PrEP and ART delivery for HIV serodifferent couples in 12 public health facilities in central Uganda (Clinicaltrials.gov NCT03586128). Using qualitative data, we identified and characterized key implementation processes that explain how PrEP delivery was integrated into existing ART services in the Partners PrEP Program. In-depth interviews were conducted with a purposefully-selected sub-sample of 83 members of 42 participating serodifferent couples, and with 36 health care providers implementing integrated delivery. High quality training, technical supervision, and teamwork were identified as key processes supporting providers to implement PrEP delivery. Interest in the PrEP program was promoted through the numerous ways health care providers made integrated ART and PrEP meaningful for serodifferent couples, including tailored counseling messages, efforts to build confidence in integrated delivery, and strategies to create demand for PrEP. Couples in the qualitative sample responded positively to providers' efforts to promote the integrated strategy. HIV-negative partners initiated PrEP to preserve their relationships, which inspired their partners living with HIV to recommit to ART adherence. Lack of disclosure among couples and poor retention on PrEP were identified as barriers to implementation of the PrEP program. A greater emphasis on understanding the meaning of PrEP for users and its contribution to implementation promises to strengthen future research on PrEP scale up in sub-Saharan Africa.

Effectiveness of Mediterranean Diet on Daytime Sleepiness among Individuals with Type 2 Diabetes Mellitus in Oman.

Background Sleep disturbance is a major complaint among individuals with diabetes mellitus and may be augmented by dietary interventions. The objective of this randomized controlled trial was to determine the effectiveness of a Mediterranean diet intervention on daytime sleepiness among individuals with type 2 diabetes mellitus (T2DM) in Oman. Methods In total, 134 eligible individuals with T2DM (61 and 73 participants in the intervention and control groups, respectively) were recruited. The intervention participants underwent a 6-month Mediterranean diet intervention consisting of individual dietary counseling, cooking classes, phone calls, and social media messages, while the control group continued with standard diabetes care. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. All data was analyzed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Results Daytime sleepiness was evident, with ∼ 30% of the participants experiencing it, with no significant difference between control and intervention participants at baseline. There was a significant reduction in daytime sleepiness in both the intervention and control groups after 6 months, with daytime sleepiness significantly lower in the intervention group, with a modest difference of 42.56% ( p < 0.001). Conclusion Adherence to the Mediterranean diet is effective in reducing daytime sleepiness among individuals with T2DM. Clinical Trial UMIN000041152.

Children's sex composition and modern contraceptive use among mothers in Bangladesh.

The stagnation and relatively low use of modern contraceptives are ongoing public health concerns in Bangladesh and other low- and middle-income countries. Although a cultural preference for sons may be linked to the current use of contraceptives, this linkage has not been adequately explored in the Bangladesh context. We investigated the effects of child sex composition on the current use of modern contraceptives. We extracted and analysed data from 17,333 women who participated in the 2017/18 Bangladesh Demographic and Health Survey. The outcome variable was the current use of modern contraceptive methods. The study factor was the parity and sex composition of the living children. We used multilevel logistic regressions to determine the association between the study factor and outcome variables, adjusting for potential covariates at the individual-, household-, and community-levels. Women with relatively high parity had higher odds of currently using modern contraceptives. Among the individual parities, compared to women with no live sons, women with one or more live sons were more likely to report currently using modern contraceptives. However, this association is significant for women up to three children. When examining both parity and children's sex composition in a regression model, in each parity category, the likelihood of using modern contraceptives tend to rise with an increasing number of sons compared to women with just one daughter. The findings of this study suggest that while the use of modern contraceptives by women increases with the increasing number of children and son preference is prevalent in Bangladesh, women also want to have a mixed composition of son and daughter. The study findings can be used in family planning programmes to customise contraceptive promotion and counselling messages.

SEXUALLY TRANSMITTED DISEASES AND COUNSELING: AN ECONOMIC EVALUATION

Sexually transmitted diseases (STDs) are among the most important diseases, with annual incidence of about 20 million cases, that impact the public health in the USA.1,2 There are several health education preventive strategies. Kamb et al studied 3 different interventions: didactic messages, brief and enhanced counseling. We analyzed the cost-effectiveness of those 3 intervention strategies using the original Kambs data and new data from the state of Georgia with different intervention effectiveness and completion rates.3We looked at the state prospective. We computed the results based on the incremental cost-effectiveness ratio (ICER), built our decision tree usingTreeAgesoftware assuming some variables that are not available in the literatures and conducted sensitivity analyses for some variables.Based on the ICER, when using the Kambs data we found that the brief counseling dominates both enhanced counseling and didactic messages. However, when we increase either one of the effectiveness or the intervention completion rates alone for the enhanced counseling, or when we increase both of them simultaneously, there was no dominant strategy.Sensitivity analyses showed that the enhanced counseling strategy became optimal if the intervention completion rates exceeded 72% or the incidence rate was less than 11.5%.From an economic point of view, we concluded by recommending against routine use of the enhanced counseling program for STDs high-risk populationsthat are not expected to complete all the counseling sessions. On the other hand, we encourage utilizing the brief counseling strategy for moderate to high-risk populations with higher probability of drops out from the program. It should substitute the current practice of didactic messages.The policy makers may consider other non-economic factors to complete the view before putting these recommendations in play.

Chatbot-interfaced and cognitive-affective barrier-driven messages to improve colposcopy adherence after abnormal Pap test results in underserved urban women: A feasibility pilot study.

Challenges in ensuring adherence to colposcopy and follow-up recommendations, particularly within underserved communities, hinder the delivery of appropriate care. Informed by our established evidence-based program, we sought to assess the feasibility and acceptability of a novel cognitive-affective intervention delivered through a Chatbot interface, aimed to enhance colposcopy adherence within an urban inner-city population. We developed the evidence-based intervention, CervixChat, to address comprehension of colposcopy's purpose, human papillomavirus (HPV) understanding, cancer-related fatalistic beliefs, procedural concerns, and disease progression, offered in both English and Spanish. Females aged 21-65, with colposcopy appointments at an urban OBGYN clinic, were invited to participate. Enrolled patients experienced real-time counseling messages tailored via a Chatbot-driven barriers assessment, dispatched via text one week before their scheduled colposcopy. Cognitive-affective measures were assessed at baseline and through a 1-month follow-up. Participants also engaged in a brief post-intervention satisfaction survey and interview to capture their acceptance and feedback on the intervention. The primary endpoints encompassed study adherence (CervixChat response rate and follow-up survey rate) and self-evaluated intervention acceptability, with predefined feasibility benchmarks of at least 70% adherence and 80% satisfaction. Among 48 eligible women scheduled for colposcopies, 27 (56.3%) agreed, consented, and completed baseline assessments. Participants had an average age of 34 years, with 14 (52%) identifying as non-Hispanic White. Of these, 21 (77.8%) engaged with the CervixChat intervention via mobile phones. Impressively, 26 participants (96.3%) attended their diagnostic colposcopy within the specified timeframe. Moreover, 22 (81.5%) completed the follow-up survey and a brief interview. Barriers assessment revealed notable encodings in the Affect and Values/Goals domains, highlighting concerns and understanding around HPV, as well as its impact on body image and sexual matters. Persistent and relatively high intrusive thoughts and lowered risk perceptions regarding cervical cancer were reported over time, unaffected by the intervention. Post-intervention evaluations documented high satisfaction and perceived usefulness, with recommendations for incorporating additional practical and educational content. Our findings underscore the robust satisfaction and practicality of the CervixChat intervention among a diverse underserved population. Moving forward, our next step involves evaluating the intervention's efficacy through a Sequential Multiple Assignment Randomized Trial (SMART) design. Enhanced by personalized health coaching, we aim to further bolster women's risk perception, address intrusive thoughts, and streamline resources to effectively improve colposcopy screening attendance.

Access and utilization of health services improved by trained posyandu cadres in rural Indonesia

Abstract Posyandu stands for ‘Pos Pelayanan Terpadu’ in Bahasa, meaning ‘Integrated Service Post,’ a community-based health center to provide a range of services for mothers and under five children in Indonesia. Each Posyandu center s served by five posyandu cadres who are community-based health workers and responsible to deliver essential health services and counseling to their communities. In Central Lombok district, Indonesia, we facilitated building capacity and skill of posyandu cadres for counseling and health education and to encourage the community to attend Posyandu center as well as to seek care from nearby Puskesmas and Polindes (other community based static health facilities). During January - August 2022, we trained 1100 posyandu cadres and equipped them with pictorial cards with health education and counseling messages. We retrieved monthly attendance and care seeking data from Puskesmas, Polindes and Posyandu centers through routine health management information system for January 2022 to February 2023 and we compared pre-training (January-August 2022) and post-training (September 2022-February 2023) data. Monthly average number of pregnant women and sick children who were brought to nearby Puskesmas and Polindes for care during pre-training period was 1553 which was significantly increased to 1844 during post-training period (p &amp;lt; 0.001). We also observed statistically significant ((p &amp;lt; 0.001) increase in average monthly attendance of mothers and children at Posyandu centres (from 12,751 in pre-training period to 14,677 in post-training period). This incremental attendance at Posyandu centers and increased care seeking from Puskesmas and Polindes can potentially be attributable to counseling-education session by trained and skilled posyandu cadres and it reconfirms the worthiness of additional investment for capacity and skill building of posyandu cadres to improve community health in rural Indonesia. Key messages • Posyandu cadres have potential strength to make significant improvement in community health care service delivery by educating and counseling communities in rural Indonesia. • Investment on capacity building and training of posyandu cadres can pay off by improving access and utilization of health care services by pregnant women and children.

High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study.

Daily oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection, but no study has evaluated combination prevention interventions with PrEP for transgender women (TGW) and men who have sex with men (MSM) who sell sex. The Combination Prevention Effectiveness (COPE) study was a community-based, non-randomized implementation study in Bangkok and Pattaya, Thailand. Participants were HIV-negative MSM and TGW aged 18-26 years who reported exchanging sex with men in the prior 12 months and who met 2014 U.S. Public Health Service PrEP eligibility criteria. The intervention included quarterly HIV testing, semiannual testing for sexually transmitted infections, provision of condoms with lubricant, and the opportunity to initiate or end daily oral PrEP use at any time during study participation. Participants taking PrEP received monthly adherence counseling and short message service reminders. The primary outcome was HIV incidence rate ratio (IRR) on PrEP vs. not on PrEP. Secondary outcomes were PrEP initiation, PrEP use at 12 months, and PrEP adherence. From October 2017 to August 2019, 846 participants were enrolled: 531 (62.8%) immediately initiated PrEP; 104 (12.3%) subsequently initiated PrEP, and 211 (24.9%) never initiated PrEP. Among those initiating PrEP within 30 days of enrollment; 85.9% were on PrEP at the 12-months. When taking PrEP, participants reported adherent PrEP use at 94.2% of quarterly assessments. Ten HIV seroconversions occurred without PrEP use (incidence rate [IR]=3.42 per 100 person-years [PY]; 95% CI=1.64-6.30), while zero cases occurred with PrEP use (IR=0.0 per 100PY; 95% CI=0.0-0.62), with IRR=0.0 (95% CI=0.0-0.22; p<0.001). Young Thai MSM and TGW who exchange sex can have high PrEP uptake, persistence and adherence, and low HIV incidence when offered in supportive community-based settings. U.S. National Institute of Allergy and Infectious Diseases; Centers for Disease Control and Prevention.

Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India.

Maternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India. This qualitative study aimed to: (1) examine pregnant women's experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption. We conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework. For ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described receiving inaccurate counseling messages. Key drivers of maternal nutrition behavior adoption were indicator specific and varied across the capability-opportunity-motivation behavior change spectrum. Findings from this study can help to strengthen future program effectiveness by identifying specific areas of program improvement.

Predictors of perceived poor social support status of pregnant women attending antiretroviral therapy clinics in south west Ethiopia, 2021

BackgroundTo improve pregnancy outcomes, a pregnant mother living with HIV/AIDS requires a high level of social and emotional support. However, women from low-income countries were subjected to low social support status despite adequate counseling and health messages to increase their social support. Therefore, this study aimed to investigate the predictors of the perceived poor social support status among pregnant women attending ART clinics in Southwest Ethiopia. MethodsA hospital-based cross-sectional study with consecutive sampling was conducted to enroll 265 pregnant women on antiretroviral therapy (ART) from December 1 to 30, 2021. The data were collected using an interviewer-administered questionnaire. Epidata was used for data entry and analyzed after it was exported to a statistical package for the social sciences. Binary logistic regression was used and the level of significance was declared at P-value <0.05 using Adjusted odds ratio at 95% CI after candidate variables were identified in binary logistic regression at a P-value of <0.25. ResultsFinding from the study figured out that low level of poor social support is found to be 47.2%. Study revealed that income level[AOR = 5.1 95% CI [1.9,13.6]], disclosure status[AOR: 1.9 95% CI [1.1,3.3]], unwanted pregnancy [AOR = 2.3 CI; [ 1.4,3.9]], and low adherence level[AOR: 2.1 95% CI [1.1,3.1]] were strong predictors. ConclusionThis study identified high levels of poor social support. Increasing access to information education and communications focusing on stigma, disclosure & refresher training that boosts the counseling skills of health care providers to enhance adherence level is strongly recommended.

An Algorithm Design about Psychological Counseling Platform Using the Derivative Works

The psychological counseling platform using the derivative works in this study includes four main modules and two sub modules. The first main one is a content database that stores a plurality of derivative works in which keywords are set. The second is a message input module including a request message providing unit that displays a request message input from the client terminal on the counselor's terminal, and a counseling message input unit that receives a counseling message written based on the request message from the counselor's terminal. The third main module is a keyword extraction module that extracts keywords by analyzing the counseling message. Final one is an answer providing module that provides derivative works corresponding to the extracted keyword and the consultation message to the client terminal. As the sub modules, this system consists of a region division module and a chart generation module. The region division module allows the screen of the client terminal to correspond to the central region where the counseling message is placed and the vertices of an equilateral triangle having the central point of the central region as the outer center. The chart generation module consists of a chart display unit, an expected value calculation unit, and a variable value setting unit. Based on the proposed algorithm, this system has the effect of increasing the effectiveness of psychological counseling and improving the concentration of counseling by providing recreated secondary copyrighted content using copyright-protected videos, images, music, and photos together with psychological counseling at the same time.

Equipping providers to offer novel MPTs: Developing counseling messages for the Dual Prevention Pill in clinical studies and beyond.

The pipeline for multi-purpose prevention technologies includes products that simultaneously prevent HIV, pregnancy and/or other sexually transmitted infections. Among these, the Dual Prevention Pill (DPP) is a daily pill co-formulating oral pre-exposure prophylaxis (PrEP), and combined oral contraception (COC). Clinical cross-over acceptability studies for the DPP require training providers to counsel on a combined product. From February 2021-April 2022, a working group of eight HIV and FP experts with clinical and implementation expertise developed counseling recommendations for the DPP based on existing PrEP/COC guidance. The working group conducted a mapping of counseling messages from COC and oral PrEP guidance and provider training materials. Six topics were prioritized: uptake, missed pills, side effects, discontinuation and switching, drug interactions and monitoring. Additional evidence and experts were consulted to answer outstanding questions and counseling recommendations for the DPP were developed. Missed pills was the topic with the most complexity, raising questions about whether women could "double up" on missed pills or skip the last week of the pack to recover protection faster. Uptake required aligning the time to reach protective levels for both DPP components and explaining the need to take DPP pills during week 4 of the pack. The potential intensity of DPP side effects, given the combination of oral PrEP with COC, was an important consideration. Discontinuation and switching looked at managing risk of HIV and unintended pregnancy when stopping or switching from the DPP. Guidance on drug interactions contended with differing contraindications for COC and PrEP. Monitoring required balancing clinical requirements with potential user burden. The working group developed counseling recommendations for the DPP to be tested in clinical acceptability studies. Uptake: Take one pill every day for the DPP until the pack is empty. Days 1-21 contain COC and oral PrEP. Days 22-28 do not contain COC to allow for monthly bleeding, but do contain oral PrEP and pills should be taken to maintain HIV protection. Take the DPP for 7 consecutive days to reach protective levels against pregnancy and HIV. Missed pills: If you miss 1 pill multiple times in a month or 2+ consecutive pills, take the DPP as soon as you remember. Do not take more than 2 pills in a day. If 2+ consecutive pills are missed, only take the last missed pill and discard the other missed pills. Side effects: You may experience side effects when you start using the DPP, including changes to monthly bleeding. Side effects are typically mild and go away without treatment. Discontinuation/switching: If you decide to discontinue use of the DPP, but want to be protected from HIV and/or unintended pregnancy, in most cases, you can begin using PrEP or another contraceptive method right away. Drug interactions: There are no drug-drug interactions from combining oral PrEP and COC in the DPP. Certain medications are not recommended due to their contraindication with oral PrEP or COC. Monitoring: You will need to get an HIV test prior to initiating or restarting the DPP, and every 3 months during DPP use. Your provider may recommend other screening or testing. Developing recommendations for the DPP as a novel MPT posed unique challenges, with implications for efficacy, cost, and user and provider comprehension and burden. Incorporating counseling recommendations into clinical cross-over acceptability studies allows for real-time feedback from providers and users. Supporting women with information to use the DPP correctly and confidently is critically important for eventual scale and commercialization.

Effects of Physical Exercise Program for Older Family Caregivers of Persons With Dementia.

Self-efficacy plays a major role in improving health behaviors. The purpose of this study was to examine the effects of a physical activity program that utilized four self-efficacy resources in older family caregivers of persons with dementia. Quasi-experimental pretest-posttest design with control group was used. Study participants were 64 family caregivers aged 60years or older. The intervention included a 60-minute group session per week for 8weeks along with individual counseling and text messages. The experimental group showed significantly higher self-efficacy than the control group. In addition, physical function, quality of life related to health, caregiving burden, and depressive symptoms were significantly improved in the experimental group in comparison with those of control group. These findings suggest that a physical activity program with a focus on the resources of self-efficacy may be not only feasible but also effective for older family caregivers of persons with dementia.

The Craving-Manager smartphone app designed to diagnose substance use/addictive disorders, and manage craving and individual predictors of relapse: a study protocol for a multicenter randomized controlled trial.

The rate of individuals with addiction who are currently treated are low, and this can be explained by barriers such as stigma, desire to cope alone, and difficulty to access treatment. These barriers could be overcome by mobile technologies. EMI (Ecological Momentary Intervention) is a treatment procedure characterized by the delivery of interventions (messages on smartphones) to people in their daily lives. EMI presents opportunities for treatments to be available to people during times and in situations when they are most needed. Craving is a strong predictor of relapse and a key target for addiction treatment. Studies using Ecological Momentary Assessment (EMA) method have revealed that, in daily life, person-specific cues could precipitate craving, that in turn, is associated with a higher probability to report substance use and relapse in the following hours. Assessment and management of these specific situations in daily life could help to decrease addictive use and avoid relapse. The Craving-Manager smartphone app has been designed to diagnose addictive disorders, and assess and manage craving as well as individual predictors of use/relapse. It delivers specific and individualized interventions (counseling messages) composed of evidence-based addiction treatments approaches (cognitive behavioral therapy and mindfulness). The Craving-Manager app can be used for any addiction (substance or behavior). The objective of this protocol is to evaluate the efficacy of the Craving-Manager app in decreasing use (of primary substance(s)/addictive behavior(s)) over 4 weeks, among individuals on a waiting list for outpatient addiction treatment. This multicenter double-blind randomized controlled trial (RCT) will compare two parallel groups: experimental group (full interventional version of the app, 4 weeks, EMA + EMI), versus control group (restricted version of the app, 4 weeks, only EMA). Two hundred and seventy-four participants will be recruited in 6 addiction treatment centers in France. This RCT will provide indication on how the Craving-Manager app will reduce addictive use (e.g., better craving management, better stimulus control) in both substance and behavioral addictions. If its efficacy is confirmed, the app could offer the possibility of an easy to use and personalized intervention accessible to the greatest number of individuals with addiction. ClinicalTrials.gov: NCT04732676.

Behavioral economics-based counseling and mobile phone text educational messages to strengthen family planning services in Jordan: a randomized control clinical trial

Behavioral economics-based counseling and mobile phone text educational messages to strengthen family planning services in Jordan: a randomized control clinical trial

Effect of messaging content on engagement with a short messaging service for perioperative smoking cessation.

We determined whether a tobacco cessation intervention targeting brief perioperative abstinence ("quit for a bit") increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence ("quit for good"). Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a "quit for a bit" or a "quit for good" intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS. The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for "quit for a bit" group (n=48) and 22.2% [4.8, 46.0] for "quit for good" group (n=50), p=0.74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes at morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, i.e., alignment of intent with intervention did not affect engagement. Tobacco cessation treatment delivered via SMS was well-accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via short message service (SMS) was feasible and well-utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates.