Improvement In Willingness Research Articles

Clinical Outcomes in a Large Sample of Youth and Adult Patients Receiving Virtual Evidence-Based Treatment for ARFID: A Naturalistic Study.

Treatment outcomes research for avoidant/restrictive food intake disorder (ARFID) has been limited to small,mixed-age feasibility trials in face-to-face care settings. This study aims to examine clinical characteristics and treatment outcomes in a large sample of youth and adult patients receiving virtual multidisciplinary team treatment for ARFID. The sample included N = 783 patients (532 youth and 251 adults) diagnosed with ARFID. Patients received cognitive behavioral therapy for ARFID (CBT-AR) or family-based treatment for ARFID (FBT-ARFID) enhanced by specialized support from a multidisciplinary team. Patients (or caregivers) completed a number of measures assessing ARFID and mood-related symptoms upon admission and throughout treatment. Youth patients on weight restoration (56%) started treatment around 85% [84%, 86%] of their target weight, and increased to 94% [93%, 96%] by week 35. Adults on weight restoration (47%) started at 85% [84%, 87%] and reached 92% [90%, 94%]. Scores improved for both groups on all PARDI-AR-Q subscales: (sensory sensitivity: b = -0.25 [-0.33, -0.16]; lack of interest: b = -0.08 [-0.16, -0.00]; fear of aversive consequences: b = -0.12 [-0.19, -0.04]). Both youth and adults demonstrated reliable improvements in willingness to try new foods (b = -0.64 [-0.89, -0.37]), anxiety symptoms (b = -0.71 [-0.95, -0.48]), and depression symptoms (b = -0.86 [-1.07, -0.64]). Youth and adult patients demonstrated reliable symptom improvements over the course of treatment across all measures, offering preliminary support for the effectiveness of FBT-ARFID and CBT-AR delivered virtually by a multidisciplinary care team.

The Influence of HIV/AIDS Literacy in Pregnant Women on Willingness to Undergo PMTCT Examination in Pematangsiantar City, North Sumatra, Indonesia

Background: In 2019, 2,370,473 pregnant women in Indonesia were tested for HIV, with 6,439 (0.27%) testing positive. Despite the importance of HIV testing during pregnancy to prevent mother-to-child transmission of HIV (PMTCT), not all pregnant women are willing to undergo testing. This study aims to evaluate the impact of health literacy about HIV/AIDS on pregnant women’s willingness to participate in PMTCT examinations in Pematangsiantar City. Methods: A quasi-experimental design with pretest and posttest, including a control group, was employed. The study population comprised pregnant women in Pematangsiantar City who had not undergone voluntary counseling and testing (VCT). A total of 102 participants (51 in the experimental group and 51 in the control group) were selected based on specific inclusion and exclusion criteria through consecutive sampling. Health literacy was measured using the Indonesian version of the health literacy questionnaire (HLS-EU-SQ10-IND). Data were analyzed using the McNemar test with a significance level set at p < 0.05. Results: In the HIV/AIDS literacy group, 32 participants (62.7%) were willing to undergo PMTCT, whereas in the control group, 32 participants (62.7%) were not willing. The literacy group showed significant improvements in willingness to undergo PMTCT after receiving information, with p-values of 0.012 (overall), 0.003 (understanding), 0.021 (assessing), and 0.007 (implementing). Conversely, the control group did not show significant changes, with p-values of 0.375, 0.210, 0.063, and 0.227, respectively. Conclusion: Health literacy about HIV/AIDS significantly enhances pregnant women’s willingness to participate in PMTCT. Increased counseling and information from health workers are crucial for improving PMTCT coverage.

The Impact of a One-Day Workshop on Good Psychiatric Management for Adolescent (GPM-A) Borderline PersonalityDisorder.

Despite evidence validating the diagnosis of borderline personality disorder (BPD) in youth, specifically showing persistence of BPD symptoms and morbidity similar to adults, there is reluctance to diagnose this in teens. Further, there is a belief among many trainees and academic child and adolescent psychiatrists (CAPs) that only specialty programs are effective, leading to treatment delays. This study charts the impact of a full-day workshop offered to an entire academic CAP department. A Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder in-person workshop was offered to department members. Participants were asked to complete a pre-survey, an immediate post-training survey, and a survey at 6months post-training. Utilizing a Qualtrics questionnaire, both linear mixed-effect models and paired t-tests were used to estimate the immediate and sustained effects of the training. Thirty-two participants completed the workshop, with 31 answering the pre-survey, 27 the post-training survey, and 23 the 6-month follow-up survey. Immediately after the training and 6months later, participants demonstrated statistically significant (p < .05) improvements in willingness to disclose the diagnosis of BPD, a reduced negative attitude around BPD, and an enhanced sense of confidence in addressing the needs of adolescents with BPD. GPM-A training can make a positive impact on groups of clinicians who work with youth who meet criteria for BPD, specifically reducing stigma, encouraging trainees and faculty members to make the diagnosis more readily, and helping them feelmore competent inaddressing the treatment needs of adolescents with BPD.

The Impact of Educational Intervention on Willingness to Enroll in a Clinical Trial of a Gonorrhea Vaccine.

Globally, >80 million new gonorrhea infections occur annually. Here, we assessed barriers to and influences on participation in a gonorrhea clinical trial and the impact of educational intervention. The survey was fielded in the US in March 2022. Higher enrollment of Black/African Americans and younger individuals than represented in the US demographic distribution reflected the higher incidence of gonorrhea in these groups. Behavioral characteristics and baseline attitudes toward vaccination were collected. Participants were probed on their knowledge of and likelihood to enroll in general and gonorrhea vaccine trials. Participants hesitant to enroll in a gonorrhea vaccine trial were given nine bullets of basic facts about the disease and asked again to rank their likelihood to enroll. Overall, 450 individuals completed the survey. Fewer participants were willing (quite/very likely) to join a gonorrhea versus a general vaccine trial (38.2% [172/450] vs. 57.8% [260/450]). The likelihood to enroll in any vaccine trial or a gonorrhea vaccine trial was greater with higher self-declared knowledge (Spearman's ρ = 0.277 [p < 0.001] and 0.316 [p < 0.001], respectively) and baseline openness towards vaccination (p < 0.001 for both). Self-declared awareness of gonorrhea was associated with age (p = 0.001), education (p = 0.031), and ethnicity/race (p = 0.002), with older, more educated, and Black/African Americans having higher awareness. Males (p = 0.001) and those with more sexual partners (p < 0.001) were more likely to enroll in a gonorrhea vaccine trial. Educational intervention had a significant (p < 0.001) impact on hesitancy. Improvement in willingness to enroll in a gonorrhea vaccine trial was greatest in those initially marginally hesitant and lowest in those initially strongly hesitant. Basic educational intervention has the potential to improve recruitment into gonorrhea vaccine trials.

Mental Health First Aid Training with the Nepalese Community in Australia: An Evaluation of Effects on Knowledge, Confidence, Intentions, Willingness to have Contact and Stigmatizing Attitudes

The aim of this study was to evaluate the effectiveness of Mental Health First Aid (MHFA) training amongst the Nepalese community in Australia by exploring the impact on knowledge about mental health first aid, confidence and intentions to help, willingness to have contact and stigmatizing attitudes towards people with mental illness. We hypothesized that since MHFA has been extensively evaluated with other communities and has been found to be effective, it would therefore be effective with this community as well. MHFA training was conducted by an accredited Nepalese-Australian MHFA Instructor with 162 participants from the Nepalese community in four states of Australia. Participants completed an evaluation questionnaire prior to the training (pre-test) and at the end of the training (post-test). The evaluation questionnaire assessed participants? knowledge about what was taught in the course, ability to recognize depression as described in a vignette, confidence in providing help, intentions to provide help, and willingness to have contact and stigmatizing attitudes towards people with mental illness. There were large improvements from pre-test to post-test in knowledge, confidence and intentions to help, medium improvements in willingness to have contact, small-to-medium improvements in stigmatizing attitudes and small improvements in recognition of depression. Participants gave high ratings of the course and the instructor. MHFA training produced improvements in knowledge, confidence, intentions, willingness to have contact and stigmatizing attitudes. The training was also well received. Further research is needed to assess persistence of these effects following the course and any changes in mental health first aid provided to the community.

Train to Reason: Sports and the Girls’ Math-Reading Gap

The aim of this paper is to evaluate if involvement in sport may generate an improvement in girls’ performance in math scores relative to those in reading. Using data from the Programme for International Student Assessment (PISA, 2015) on test scores of Italian high school students we implement an Instrumental Variable strategy designed to establish the causal relationship between sports and test scores. The econometric strategy relies on two features, namely, 1) the use of mother education as an instrument to predict the level of sports performed by girls and 2) the use of the ratio of math and reading scores as the main interest-dependent variable to eliminate from the residuals unobserved elements that may shape schooling ability and are likely to be correlated with the educational level of mothers. Results highlight that physical activity improves math test scores for girls. We argue that involvement in sports for girls may make up for the lack of out-of-the-home experiences that typically takes place during childhood, generating an improvement in willingness to compete as well as in the ability to perform strategic and logical reasoning under pressure, fostering math performance.

Improvement in Willingness to Purchase Taurine-Containing Jelly Needs High Degrees of Interest and Preference: Focused on Korean College Students.

Recently, taurine-containing jellies have been sold in Korea, which provides a source of dietary taurine suspended in jelly and considered as a snack. This study was conducted to investigate factors (recognition, consumer preference, and improvement points) that potentially increase the willingness of consumers (Korean college students) to purchase the taurine-containing product. A total of 561 subjects were compared according to gender (260 male and 301 female college students) and degree of interest in taurine-containing jelly (276 subjects interest group and 285 subjects in indifferent group). Data were collected using an anonymous self-administered questionnaire and a consumer preference evaluation. Statistical analyses were performed using SPSS 25.0. The factors most important in determining the willingness to buy taurine-containing jelly were price and efficacy for male students (p<0.05), taste (p<0.05), and brand (p<0.01) for female students. Nutrient and weight were more important in the interest group than the indifferent group (p<0.05). Preference consumer scores of the taurine-containing jelly rated aroma, texture, and taste significantly higher among male college students than those of the female college students. Moreover, preference scores of all items were significantly higher in the interest group than in the indifferent group. The interest group was more knowledgeable about taurine than the indifferent group (p<0.001). Willingness to purchase (average 3.1 points) and intention to recommend (average 3.1 points) the taurine-containing B jelly were significantly higher in the interest group than in the indifferent group. Interest in taurine-containing jelly, overall preference, and intention to recommend in all the subjects were shown to significantly positively correlate with their willingness to purchase. These results show that it is necessary to increase the degree of interest, preference, and intention to recommend to improve the willingness to purchase taurine-containing jelly by Korean college students. In particular, since the subjects who had knowledge of taurine were interested in taurine-containing jelly, nutritional education and promotion of taurine should help in the selling of the product.

Patient Education of Osteopathic Manipulative Medicine as a Gateway to Treatment: A Pilot Study

Abstract Context The use of osteopathic manipulative medicine (OMM) continues to decline in medical practice, despite an increasing number of osteopathic physicians. Objective This pilot study was designed to determine if a brochure created to increase knowledge about osteopathic medicine and OMM was read by patients, reviewed as being helpful, needed modifications and increased patient understanding of and willingness to receive OMM in preparation for a large scale trial that will assess this in both the hospital and ambulatory settings. Methods The study was performed using an educational brochure and 2 closed questionnaires. Twenty-seven patients of either inpatient or observation status aged 18 and above with English literacy were enrolled. Participants first completed a pre-questionnaire with questions regarding understanding of OMM and willingness to receive treatment. They then read the provided educational brochure, which contained a checkbox to verify the material was read in its entirety. Participants completed a post-questionnaire with similar questions. The results were analyzed with Wilcoxon signed rank test with 95% confidence to observe any changes in pre- and post-questionnaire responses. Results Of the participants, 48.1% provided verification that they read the brochure. A significant increase in patient willingness to receive OMM as part of their treatment regimen was observed for those who read the brochure (P=.008 ). No significant change was seen for those who didn’t read the brochure (P=.26). Additionally, 100% of participants indicated that the brochure was helpful, and 100% of participants indicated a better understanding of OMM. Cost remained a significant barrier to accepting or pursuing OMM treatment. Conclusion This pilot study demonstrated a statistically significant improvement in willingness to receive treatment after reviewing the designed brochure. It also identified a need to convey information regarding cost of OMM treatment to patients and a need to better emphasize the checkbox located within the brochure for verification purposes. The brochure and study design proved feasible and will provide the foundation for a larger scale trial looking to assess if a patient educational handout improves understanding of OMM and willingness to receive treatment in the hospital and ambulatory settings.

Layperson Ability and Willingness to Use Hemostatic Dressings: A Randomized, Controlled Trial

Background: The Hartford Consensus and Stop the Bleed Campaign empower the public to stop bleeding. While evidence for civilian tourniquet use is mounting, there is limited evidence regarding the public's ability to use hemostatic dressings. This study seeks to determine if laypeople can apply hemostatic dressings, and which hemostatic dressing they can use most successfully. Methods: 360 layperson participants in Maryland and Virginia completed 4 arms of this randomized, prospective controlled trial: plain gauze (control), z-folded gauze, s-rolled gauze, and injectable sponge (experimental) arms. Participants watched a standardized video, practiced hands-on dressing application, and were assessed applying the dressing via checklists and feedback mechanisms for pressure, timing, and packing. Participants completed pre and post questionnaires regarding willingness to use hemostatic dressings. Results: Overall, 202 participants (56%) applied the dressings correctly, and 83 (92%) applied the injectable sponges correctly. This is a significant difference from the other arms (p < 0.001), and OR 17.2 (95% CI 6.8 – 48.1) compared to control. 38 participants (40%) correctly applied plain gauze, while 37 (43%) and 44 (48%) participants correctly applied z-folded and s-rolled gauzes. The primary reasons for failure were not holding pressure long enough (n = 103, 65%) and not applying adequate pressure (n = 64, 41%). Participants in all arms had significant improvements in willingness to use hemostatic dressings: 154 (43.6%) participants pre vs. 344 (97.5%) post study participation (p < 0.001). Conclusions: More than half of laypeople can apply hemostatic dressings, and they are most successful applying injectable sponges. Brief education increases laypeople's reported willingness to use hemostatic dressings. Educators and planners should consider including injectable sponges in their Stop the Bleed programs and products. Level of Evidence: II (RCT with significant difference. One negative criterion for observer blinding).

Improving access to interventions among mothers screened positive for post-partum depression (PPD) at National Programme on Immunization (NPI) clinics in south-western and south-eastern Nigeria - A service development report.

We investigate the possibility of improving access to interventions among mothers screened positive for post-partum depression (PPD) at National Programme on Immunization (NPI) clinics randomly selected from Lagos and Enugu States in south-western and south-eastern Nigeria respectively. The principle of human centred design was employed by engaging the mothers screened positive for PPD to be part of the decision making regarding their further assessment and intervention services. The study brought intervention services to primary healthcare centre at the NPI clinics. Improvement in willingness to seek interventions was observed among the mothers screened positive for PPD in this study when compared to our observation in a previous report, where mothers diagnosed with PPD were referred and requested to visit a mental health facility closer to their NPI clinics for further assessment and interventions (95.2% versus 33.7%). Interventional services for the mothers diagnosed with PPD also impact positively on the growth parameters of their infants on follow-up. Principle of human centred design improved access to intervention services among the mothers and infants studied. NPI clinics at primary healthcare level would provide appropriate forum for early screening of mothers for PPD and interventions in low-resource setting like Nigeria. There would be improvement in maternal and child health coverage if the Nigerian Government can adapt human centred design principles employed in this study nationwide.

Effect of population-based training programs on bystander willingness to perform cardiopulmonary resuscitation

Objective. This study was performed to determine the factors related to unwilling-ness of bystanders to perform cardiopul-monary resuscitation (CPR), and improve-ment of willingness among the lay public after CPR training.Design. Retrospective designMethods. We collected questionnaires received from laypersons attending CPR training courses implemented by the CPR Improvement Program of Chang Gung Memorial Foundation. Pre- and post-training questionnaires were given to par-ticipants attending CPR training courses between September 2013 and January 2014.Results. Among the 401 respondents at pre-training, higher educational level (odds ratio, 3.605; 95% confidence in-terval [CI], 3.055 – 8.284) and previous CPR training (odds ratio, 1.754; 95% CI, 1.049 – 2.932) were significantly associ-ated with willingness to perform bystander CPR. Significant improvements in will-ingness to perform conventional CPR and hands-only CPR on a stranger were observed after training (P = 0.016 and P < 0.0001, respectively). Approximately half of the respondents claimed that fear of doing further harm was the primary rea-son for their lack of willingness to admin-ister conventional CPR on a stranger.Conclusions. We showed that CPR train-ing significantly increased the rate of will-ingness to perform CPR on strangers as well as acquaintances among the lay pub-lic. This study also showed that fear of do-ing further harm was the most significant barrier after training. This concern should be addressed in future training programs.

Abstract 30: Behavioral Change after Heart Disease Risk Assessment in Women

Background: Heart disease is the leading killer of women in the United States. Unfortunately, most women are unaware of their individual risk. Studies have shown that awareness of cardiovascular (CV) disease risks correlates with positive behavior changes, including increased physical activity and weight loss. Methods: The Change of Heart (COH) Program is a university hospital based CV disease risk assessment program. The assessment included baseline weight, height, blood pressure, lipid profile, fasting glucose, and Framingham risk score in women 18 years of age and older. A 90-minute individual discussion of risk and recommendations for healthy lifestyle changes were given. Follow up questionnaires and newsletters designed to assess and encourage heart-healthy behavioral changes were given at 3 and 6 months after the initial visit to participants. We compared baseline vs. follow up self-reported activity levels and readiness for change. Results: At baseline, participants’ average age was 50.6 years, they exercised between 1 to 3 hours each week, and most had either never smoked or had quit smoking. When asked what they thought a woman’s greatest health problem was, 62% answered Heart Disease/Heart Attack. Additionally, 59% of participants felt moderately informed about women’s heart disease and 54% would call 911 if they thought they were having a heart attack. We found a statistically significant improvement in willingness to increase physical activity (p &lt; 0.001), practice good eating habits (p &lt; 0.001), avoid smoking (p &lt;0.01), lose or maintain healthy weight (p &lt;0.001), lower and maintain cholesterol levels (p &lt; 0.001) and blood pressure (p &lt; 0.001) over the course of the study. Conclusion: In a population of women who felt that they were moderately well informed on heart disease, only 62% knew that a woman’s greatest health risk was heart disease or a heart attack. Most women showed improvements in readiness for positive heart-healthy behavioral changes. This emphasizes the ability for a cardiovascular risk reduction program to positively influence a woman’s willingness for behavioral change.

Pilot study of Internet-based early intervention for combat-related mental distress

This article evaluates an Internet-based early intervention combining online cognitive-behavioral therapy (CBT) with electronic peer-to-peer support intended to promote mental health and well-being among combat veterans. We conducted a phase 1 clinical trial of 50 Iraq and Afghanistan veterans using a pre and post single-arm design. We evaluated feasibility and changes in mental health symptoms (depression and posttraumatic stress disorder [PTSD]), functional status, and attitudes toward treatment seeking at baseline and weeks 4, 8, and 12. A diverse group of veterans was enrolled (26% ethnic minority, 90% male, 66% with income <$30,000/year, 88% with no prior treatment for depression). Participants completed a mean of 4 of 6 lessons (standard deviation = 2.54). From baseline to week 12, there were significant declines in the Center for Epidemiologic Studies-Depression scale score (effect size [ES] = 0.41) and PTSD Checklist-Military version score (ES = 0.53). There were significant improvements in willingness to accept diagnosis (ES = 1.08) and perceived social norms and stigma regarding friends (ES = 1.51). Although lack of a control group is a limitation, the Internet-based program combining CBT-based coping skills training and peer-to-peer support demonstrated potential feasibility and evidenced benefit in symptom remediation for depression and PTSD.

Treatment of hyperkinetic emotionally disturbed children with prolonged administration of chlorpromazine.

Twenty-five hyperkinetic, emotionally disturbed children were treated with chlorpromazine for periods lasting from 4 to 16 months. They also served as their own controls by receiving placebo medication for 4 to 6 weeks during some phase of treatment. Response was determined from the following observations: (1) Clinical changes noted by the clinic staff which included the social worker and psychologist as well as the therapist; (2) data from the home environment; (3) reports from the school counselors; (4) changes in the battery of psychological tests done before and after treatment. Improvement in varying degrees was noted in 21 cases—84%, and was marked in 70%. Diminution in hyperactivity was the outstanding phenomenon. Combativeness was reduced considerably. There was definite improvement in willingness to learn. The psychological testing suggested that the learning process was facilitated. Trends toward increased emotional control were evidenced although the basic personality seemed unchanged. The procedure was effective because an "improved interpersonal relationship" could be established and exploited for the sake of the learning process. The side effects were minimal compared with those of adults and did not necessitate the termination of treatment in any case. Sequential blood count studies were negative. It is suggested that, perhaps for the first time, we have a drug which dampens the primitive fight-flight responses, possibly actuated by the "arousal system" of Magoun (15). It is further suggested that by controlling this basic mechanism without impairing consciousness and the learning process, we can now do more effective psychotherapy. We seem to have entered the era of "combined therapy" where drug therapy and psychotherapy are complementary and can be combined to change the personality most effectively.