Intervention Participants Research Articles

A randomised controlled implementation study integrating patient self-screening with a remote central monitoring system to screen community-dwellers aged 75 years and older for atrial fibrillation.

Diagnosis of atrial fibrillation (AF) provides opportunities to reduce stroke risk. This study aimed to compare AF diagnosis rates, participant satisfaction and feasibility of an electrocardiogram (ECG) self-screening virtual care system with usual care. This randomised controlled implementation study involving community-dwelling people aged ≥75 years was conducted from May 2021 to June 2023. Participants were given a handheld single-lead ECG device and trained to self-record ECGs once daily on weekdays for 12 months. The control group received usual care with their general practitioners in the first 6 months and participated in the subsequent 6 months. AF diagnosis and participant satisfaction were assessed at 6 months. 200 participants (mean age 79.0±3.4 years; 54.0% female; 72.5% urban). AF was diagnosed in 10/97 (10.3%) intervention participants and 2/100 (2.0%) in the control group (Odds Ratio 5.6, 95% CI 1.4-37.3, p=0.03). In the intervention, 80% of AF cases were diagnosed within 3 months. 91/93 (97.9%) intervention participants and 55/93 (59.1%) control-waitlisted participants (p<0.001) were satisfied with AF screening. Of the expected 20 days per month, the overall monthly median number of days participants self-recorded ECGs was 20 (interquartile range 17-22). Participants were confident using the device (93%), reported it was easy to use (98%) and found screening efficient (96%). Patient-led AF self-screening using single-lead ECG devices with a remote central monitoring system was feasible, acceptable, and effective in diagnosing AF among older people. This screening model could be adapted for implementation, interfacing with integrated care models within existing health systems.

Emerging SARS-CoV-2 Resistance After Antiviral Treatment.

Previous studies have identified mutations in SARS-CoV-2 strains that confer resistance to nirmatrelvir, yet how often this resistance arises and its association with posttreatment virologic rebound is not well understood. To examine the prevalence of emergent antiviral resistance after nirmatrelvir treatment and its association with virologic rebound. This cohort study enrolled outpatient adults with acute COVID-19 infection from May 2021 to October 2023. Participants were divided into those who received antiviral therapy and those who did not. The study was conducted at a multicenter health care system in Boston, Massachusetts. Treatment regimen, including none, nirmatrelvir, and remdesivir. The primary outcome was emergent SARS-CoV-2 antiviral resistance, defined as the detection of antiviral resistance mutations, which were not present at baseline, were previously associated with decreased antiviral efficacy, and emerged during or after completion of a participant's treatment. Next-generation sequencing was used to detect low frequency mutations down to 1% of the total viral population. Overall, 156 participants (114 female [73.1%]; median [IQR] age, 56 [38-69] years) were included. Compared with 63 untreated individuals, the 79 who received nirmatrelvir were older and more commonly immunosuppressed. After sequencing viral RNA from participants' anterior nasal swabs, nirmatrelvir resistance mutations were detected in 9 individuals who received nirmatrelvir (11.4%) compared with 2 of those who did not (3.2%) (P = .09). Among the individuals treated with nirmatrelvir, those who were immunosuppressed had the highest frequency of resistance emergence (5 of 22 [22.7%]), significantly greater than untreated individuals (2 of 63 [3.1%]) (P = .01). Similar rates of nirmatrelvir resistance were found in those who had virologic rebound (3 of 23 [13.0%]) vs those who did not (6 of 56 [10.7%]) (P = .86). Most of these mutations (10 of 11 [90.9%]) were detected at low frequencies (<20% of viral population) and reverted to the wild type at subsequent time points. Emerging remdesivir resistance mutations were only detected in immunosuppressed individuals (2 of 14 [14.3%]) but were similarly low frequency and transient. Global Initiative on Sharing All Influenza Data analysis showed no evidence of increased nirmatrelvir resistance in the United States after the authorization of nirmatrelvir. In this cohort study of 156 participants, treatment-emergent nirmatrelvir resistance mutations were commonly detected, especially in individuals who were immunosuppressed. However, these mutations were generally present at low frequencies and were transient in nature, suggesting a low risk for the spread of nirmatrelvir resistance in the community with the current variants and drug usage patterns.

Co-creating a Mpox Elimination Campaign in the WHO European Region: The Central Role of Affected Communities.

Between May 2022 and September 2023, the World Health Organization (WHO) Regional Office for Europe engaged in a collaborative effort with affected communities to address the outbreak of mpox in the region. This concerted endeavor led to the development of a risk communication campaign specifically tailored to address the perceptions and needs of the target audience, thereby contributing to the control and the long-term goal of mpox elimination. Various community engagement interventions were implemented, including the establishment of an informal civil society organizations' working group to provide feedback on the WHO mpox campaign, webinars targeting event organizers, and roundtable discussions with country-level responders. The invaluable feedback garnered from the community was utilized to customize materials and extend outreach to groups that may have been overlooked in the initial response. This successful initiative underscored the immense potential of placing communities at the forefront of emergency response efforts, equipping them with the necessary resources, engagement, and empowerment. This offers 1 model of co-creation that can be applied to health emergencies. It is asserted that the pivotal role played by communities in this response should be recognized as a valuable lesson and incorporated into all emergency responses, ensuring sustained community involvement and empowerment throughout the entire emergency cycle.

Изучение психосоциальных факторов, влияющих на приверженность пациентов к лечению хронических заболеваний.

This research article scrutinises the psychosocial underpinnings that influence adherence to treatment among patients with chronic diseases, assuming that adherence is a multifaceted phenomenon shaped by a complex set of psychosocial factors. Purpose: the aim of the study is to uncover the complex relationship between these factors and adherence to treatment, using linear sampling to capture the dynamics and temporal evolution of adherence behaviour in the context of chronic illness. Materials and methods. Using a rigorous methodological framework, participants with many chronic conditions were included in the study, with inclusion and exclusion criteria carefully developed to ensure a representative and diverse group. The study utilised a range of validated psychometric tools to quantify psychosocial variables such as social support, stress levels and health beliefs, as well as a multifaceted approach to assess adherence combining self-report, pharmacy records and biometric measures. Advanced statistical analyses, including mixed-effects models and structural equation modelling, were used to identify relationships between psychosocial factors and adherence to treatment, taking into account the complexity and longitudinal nature of the data. Results. The findings highlight the critical role of social support in increasing treatment adherence as well as the detrimental effects of elevated stress levels, emphasising the critical interplay between individual psychological resilience and external support systems. The study also clarifies the influence of health beliefs and illness perceptions on adherence behaviour, advocating a better understanding of the cognitive and affective dimensions that determine patients’ engagement in treatment. Findings. The article concludes by arguing that a paradigm shift towards integrating psychosocial support mechanisms into holistic models of care is needed to increase adherence in chronic disease management. It calls for the implementation of health care policies and practices that not only address the biomedical aspects of chronic disease, but also the psychosocial complexities inherent in long-term disease management. Findings from the study encourage further research into specialised psychosocial interventions aimed at improving adherence and consequently quality of life for people coping with the challenges of chronic illness.

"What Is Normal?": A Qualitative Exploration of Health Practitioners' Reports of Treating Patients Presenting with Unpleasant Sexual Experiences.

Sexual health, including sexual pleasure, is fundamental to holistic health and well-being, and is considered an area of priority health in Australia. Despite the importance of sexual functioning, women experience significant gaps in sexual well-being compared to men and often do not seek medical care or treatment. Health practitioners are central to the identification and treatment of sexual dysfunction, including fostering sexual well-being for patients. Despite this, minimal research has explored health practitioners' experiences in treating reports of unpleasant sex. This study aimed to explore health practitioners' experiences, responses, and confidence in treating patients presenting for unpleasant sexual experiences. An online, mixed-methods survey was completed by 96 participants. Thematic analysis identified 11 core themes. These themes included five patient centred themes (health risks, diverse sex acts, painful vaginal intercourse, relationship breakdown and violence, unwanted sex) and six health practitioner centred themes (communication and counselling, what is normal, ongoing care and follow up, emotional response, limited practical training, and highly prevalent). Participants described a complex sexual health landscape, with social contexts impacting women's sexual experiences and engagement in treatment. Additionally, health practitioners reported the need for a biopsychosocial approach to understanding and responding to unpleasant sexual experiences for patients, while simultaneously reporting limited education in this area. Findings reflect the need for health practitioners to be cognisant of matters related to sexual function, consent, coercion, client engagement, and treatment pathways, identifying a need for greater education and holistic approaches to sexual healthcare across medical settings.

Agro-Pastoral Youth Participation in Livelihood Activities, Development Programs and Interventions in East and West Hararghe Zones of Oromia Regional State, Ethiopia

This study was conducted to identify the status and determinants of male and female youth participation in selected livelihood activities, development programs and interventions in agro-pastoral areas of Oromia regional state, Ethiopia. A cross-sectional research design and mixed methods research approach were employed. A multi-stage random sampling strategy was followed to select four agro-pastoral Woredas (A ‘Woreda’ is an administrative unit equivalent to a District), 12 Kebeles (A ‘Kebele’ is the smallest administrative unit in Ethiopia. A Woreda/District consists of several Kebeles) and 398 youth aged 15–29 years for a face-to-face interview. Data were analysed through descriptive and inferential statistics and an econometric model (Logistic regression) estimation. We found that whereas male youth had better access to land, participation in extension/advisory services and Farmers’ Training Centers (FTCs), agricultural training, and NGOs, female youth had better participation in non-/off-farm livelihood activities and Productive Safety Net Program (PSNP). Our findings indicated that lack of access to financial resources, limited access to land, poor extension and rural advisory services, limited skills development programs and mentorship were key factors affecting youth participation. Other factors include: targeting criteria, discrimination (e.g. on the basis of gender, social structure), cumbersome organizational procedures and requirements, limited availability and capacity of supporting organizations, poor infrastructural developments, mismatch between needs and services provided, conflict, and climate-induced shocks and uncertainties. To overcome these challenges, local and regional governments and their development partners operating in the area should implement a multi-stakeholder, participatory, co-design and development of programs, projects and interventions to enhance collaboration, youth engagement and benefit. Investments in capacity-building and alternative income-generating activities, entrepreneurship education and business skills training are also important.

Intervention model in reducing the unmet need for contraception: a systematic literature review on technology-based, community, and health worker interventions

The unmet need for contraception is a serious public health problem, and efforts to reduce the unmet need for family planning are a challenge due to the many and complex factors that contribute to the unmet needs. The aim of this study was to systematically review scientific evidence on intervention models that effectively reduce the unmet need for contraception. This study used a systematic review to identify relevant scientific articles. The article search was based on the PICO approach and used a database from https://www.scopus.com/, https://www.sciencedirect.com/, https://pubmed.ncbi.nlm.nih.gov/, https://www.mdpi.com/, https://www.jstor.org/, https://www.nature.com/, https://link.springer.com/. The reviewed material was full-text articles and open-access articles published from 2013 to 2023. Data extraction included author, country, type of intervention, research design, sample, and main research findings. Twelve studies were included in our qualitative synthesis. Technology-based interventions, such as mobile phone instant messaging apps, were implemented in countries like Tajikistan, Bolivia, and Mozambique. Community-based interventions included the Community Family Health=Family Wealth program in Uganda, the Tékponon Jikuagou (TJ) program in Benin, and the Married Adolescent Girls Club (MAG club) and Participatory Women's Group Intervention in Bangladesh. Health worker-led interventions involved community health volunteers in Nepal, postpartum contraceptive counseling, contraceptive counseling for all ages, structured counseling for childbearing couples in Indonesia, and the "Consult and Choose" client-centered family service in Jordan. The findings underscore that varying intervention models can significantly enhance contraceptive use, tailored to specific cultural and regional contexts. These interventions, therefore, hold substantial implications for public health practices aiming to address and reduce the global unmet need for contraception. This systematic review provides valuable insights into the effectiveness of diverse interventions and suggests avenues for public health strategies to expand contraceptive access and use globally.

Problem Sexual Behavior and Engagement in Therapeutic Intervention among Children Aged 4–12

ABSTRACT Early intervention in problem sexual behavior (PSB) is critical; however, little is known about the engagement of children and families in therapeutic intervention for PSB. This research explored the characteristics, presenting issues, and engagement of 242 children aged 4–12 years attending a therapeutic service for PSB. Most frequently, PSB occurred within sibling relationships. Girls were more likely to engage in PSB alone (self-directed or non-targeted behaviors), while boys were more likely to involve other young people (interpersonal PSB). One-third (35%) of clients engaged in completion of therapy. Parental noninvolvement and self-directed or non-targeted PSB predicted early disengagement. Client demographics, sexual abuse, and interpersonal sexual behaviors were not associated with therapy completion. Implications for therapeutic intervention in children’s PSB are discussed.

Feasibility of Concussion Essentials: A multimodal intervention for persisting post-concussion symptoms among children and adolescents

ABSTRACT This study examined the feasibility of “Concussion Essentials” (CE), an individualized, multimodal intervention for persisting post-concussion symptoms (pPCS). Thirteen 6–18 year-olds with pPCS at 1-month post-concussion, as determined by the Post Concussion Symptom Inventory – Parent Report (PCSI-P), completed education, physiotherapy, and psychology modules, for up to 8-weeks or until pPCS resolved. Intervention participants were matched to a longitudinal observational cohort who received usual care (n = 13). The study enrolled 70% of participants symptomatic on screening and the dropout rate was <30% between baseline and post-programme assessments (4-weeks to 3-months post-injury). Symptoms improved for 100% of CE participants, with the number of symptomatic items on the PCSI-P reducing from 4-weeks, Median (IQR) = 14.0 (8.0–19.0) to 3-months, Median (IQR) = 1.0 (0.0–5.0). Comparatively, symptoms improved for approximately half of matched usual care participants. CE participants (n = 8) and their parents (n = 11) completed acceptability questionnaires. Most parents (91%) agreed CE was acceptable for children with concussion. All participants agreed CE was appropriate for concussion, while approximately 88% agreed they enjoyed the intervention and would recommend CE to others. Findings suggest CE is a feasible and acceptable treatment for paediatric pPCS. Further investigation within a larger scale randomized clinical trial is warranted.

Abstract A127: Enhancing partnerships to address cancer screening disparities: community engagement strategies in a colorectal cancer screening navigation trial

Abstract Intro While researchers are expected to address study participants’ social determinants of health (SDOH), little to no empirical work is dedicated to the science of how to advance partnerships to redress health disparities. The aims of the study are to describe engagement methods to recruit community based organizations (CBOs) in a clinical trial designed to test the navigation of patients through colorectal cancer (CRC) screening while also creating linkages to help address patients’ SDOH. Methods Federally qualified health center (FQHC) staff invited CBO representatives to participate in the trial’s formative assessment components, food box provision, and/or delivery of CRC screening education. This engagement relied on relationships built through the team’s facilitation of a community coalition- a network that already existed in the FQHC. Study records were reviewed to enumerate and tally engagement approaches over the course of the study’s first 2 years. Results Seven CBOs provided a letter with the grant’s submission: 4 CBOs expressed interest in participating in an advisory board; 2 CBOs committed to providing a food box to patients identified with food insecurity; and 1 CBO committed to delivering community CRC screening education. Of the 7 CBOs, 6 completed a key informant interview; 2 provided zip-code level expertise to define study neighborhoods; and 2 developed formal agreements to provide food boxes to intervention participants. There was a change in leadership with 4 of the 7 CBOs, which likely explains the missing interview. Of the 2 partners that committed to food box provision, at the time of implementation- 1 of these no longer had a food pantry function as the CBO had taken this role on during the COVID pandemic’s peak. A neighboring site, however, continues to provide this service and has stepped in to provide food boxes for the study. Similarly, the CBO that had committed to providing community CRC education no longer has capacity to do so and a new partner was engaged to deliver this health education. At the end of grant year 1, to identify additional CBOs that could supply food boxes in other study neighborhoods, staff emailed 2 CBOs that were recommended during interviews, however, we received no response. Half-way through grant year 2, staff reengaged the dedicated CBO engagement team and requested additional e-introduction to new CBO partners that could address patients’ SDOH in these other study neighborhoods. Six CBOs have been approached with 1 interview completed to date. One of these year 2 CBOs provided zip-code level expertise to the study’s analytical team while another CBO is developing a formal agreement to provide food boxes in the other study areas. Conclusions Having a group dedicated to CBO engagement has allowed the research team to conduct outreach and partner with CBOs to co-deliver the intervention to address patients’ SDOH. Additional work is needed to consider the transitions in CBOs which impact initial commitments and timeline in order to anticipate and address these challenges early in a study. Citation Format: Anne Escaron, Joanna Garcia, Adriana Aranda, Jacqueline Macias-Sandoval, Dina Cruz Quintanilla, Crystal Gomez, Elva Arredondo, Gloria Coronado. Enhancing partnerships to address cancer screening disparities: community engagement strategies in a colorectal cancer screening navigation trial [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A127.

Cognitive flexibility and emotion regulation in eating disorder patients with comorbid generalized anxiety and posttraumatic stress symptoms

ABSTRACT Research has found that difficulties in emotion regulation negatively impact mental health, whereas cognitive flexibility may promote stress resilience and positive mental health. Little is known about cognitive flexibility and emotion regulation in people with comorbid eating disorder (ED) and anxiety and stress disorders. A transdiagnostic ED population (N = 227) at an outpatient ED treatment facility completed several self-report instruments that measured cognitive flexibility, emotion regulation difficulties, posttraumatic stress disorder (PTSD) symptoms, and generalized anxiety disorder (GAD) symptoms upon admission. We investigated cognitive flexibility and emotion regulation differences for those with an ED without comorbidity and those with various combinations of comorbidity. In a one-way between-groups ANOVA, we investigated differences in cognitive flexibility for those with GAD, PTSD, neither, and both comorbidities. We found a statistically significant difference between these groups, with mean cognitive flexibility inventory scores being the lowest in the group with both comorbidities. However, when controlling for emotion regulation, a one-way between-groups ANCOVA indicated no significant differences in cognitive flexibility between comorbidity groups F(3, 222) = 1.20, p = .31 Partial η 2 = .02. Though self-reported cognitive flexibility levels differ among ED patients with and without comorbidities, it appears that these differences are better explained by emotion regulation. Therefore, addressing emotion regulation early in treatment for all individuals with EDs, regardless of comorbidity, is recommended as a future research focus to enhance treatment outcomes. Further research is needed to understand the impact of treating emotion regulation on ED treatment engagement, dropout, and effectiveness.

Camp-style lifestyle modification program (CAMP) for diabetes prevention among rural women with prior GDM: study protocol for a three-arm cluster hybrid type 2 randomized controlled trial

BackgroundIntensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes.MethodsA three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions.DiscussionThe CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings.Trial registrationRegistered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022.

A feasibility study of a participatory designed program for preventing cardiovascular disease in mentally vulnerable patients

Aim To test the feasibility of a participatory design intervention aimed at reducing the risk of cardio-vascular disease among patients suffering from alcohol use disorder (AUD) or severe mental illness (SMI). Methods The intervention was developed by patients from the Community Mental Health Center and the Alcohol Treatment Facility in Odense, Denmark, and consisted of eight modules (health interviews, screening and treatment, introduction, diet/alcohol, physical activity, smoking, health app, and sleep problems). The intervention was tested using pre- and post-measurements of selected variables, patients’ intervention attendance, and interviews and dialogue workshops at the end of the study. Results A total of 21 out of 42 eligible patients from the Alcohol Treatment Facility and two out of 443 eligible patients from the Community Mental Health Center accepted participation in the study. The two patients from the Community Mental Health Center were not included in the analyses due to General Data Protection Regulation (GDPR). All patients accepted being screened for risk factors at inclusion, and the majority enrolled in at least one of the subsequent modules. The study indicated that the patients followed recommendations from their GPs. Conclusions There is a great need for focus on cardio-vascular disease in patients with SMI and those with AUD. Results indicate that the intervention is feasible for patients with AUD, but due to inclusion of too few patients with SMI, nothing can be concluded for this patient group. Patients and staff in the Alcohol Treatment Facility agreed that the intervention has future perspectives.

Preaching to the Choir A Problem of Participatory Interventions

Preaching to the Choir A Problem of Participatory Interventions

Recommendations for Academic Health Libraries Outreach and Engagement Programs with Indigenous Peoples at Collaboration and Empowerment Levels: Striving for Empowerment

A Review of: Cruise, A., Ellsworth-Kopkowski, A., Villezcas, A. N., Eldredge, J., &amp; Rethlefsen, M. L. (2023). Academic health sciences libraries’ outreach and engagement with North American Indigenous communities: A scoping review. Journal of the Medical Library Association, 111(3), 630–656. https://doi.org/10.5195/jmla.2023.1616 Objective – To identify trends and themes in literature sources on interventions for engagement and outreach by academic health sciences libraries with Native Americans, Alaska Natives, First Nations, and Indigenous peoples in the United States, Canada, and Mexico, in order to identify and share effective practices. Design – Scoping review. Setting – Academic health sciences libraries in the United States, Canada, and Mexico. Subjects – Sixty-five reports of 45 engagement and outreach programs spanning 1982-2022. Methods – Researchers conducted a scoping review guided by Arksey and O’Malley’s framework (2005) and the JBI Manual for Evidence Synthesis. They first established inclusion and exclusion criteria then developed a search strategy and ran it across seven bibliographic databases and a library and information science repository. The research team also searched specific journals, conference proceedings, and websites, to find unpublished materials and grey literature; they used mailing lists and personal contacts to find further sources. The researchers used Covidence to screen sources from the bibliographic databases, with English language sources screened by two reviewers and non-English language sources screened by at least one reviewer who could read that language. Sources found via other search methods were screened using Google Sheets, which was also used for data extraction. The researchers analyzed the data using the International Association for Public Participation (IAP2) Spectrum of Public Participation, summarizing programs within the two highest levels to synthesize effective practice. Main Results – The authors identified 45 programs with 27 types of interventions. Training was the most common intervention at 25.5%. They identified 130 different partners; government organizations, both federal and tribal, were the most common at 23.1%. Using the IAP2 Spectrum of Public Participation, a tool designed to assess the level of participation and role of the public in public participation processes, the research team found that five programes (11.1%) engaged with the community at the two highest and also most effective and meaningful levels of collaborate and empower. From these five programs the researchers identified the following areas of effective practice: 1) partnership building and building trust with tribal communities including respecting the knowledge and expertise of the community partners, 2) prioritising and understanding the needs of the tribal communities including developing awareness of cultural differences, 3) partnering with multiple organisations to increase infrastructure, resources, and funding, and, where possible, 4) building on preexisting partnerships and relationships. Conclusion – The authors concluded that libraries are likely to struggle to reach the two highest levels of the IAP2 Spectrum of Public Participation, due to issues with infrastructure, resources, long-term funding, and previous troubled relationships between governments, organizations, and researchers with Native and Indigenous populations, leading to challenges with building and sustaining partnerships. They recommend that libraries initiate any engagement and outreach programs with a needs assessment, with the goal of involving the community partners as collaborators or empowering them as owners and decision makers. The researchers also recommend engaging programs with data sovereignty to increase IAP2 levels and give communities control over their own data.

Social networks as facilitators and barriers to behavior change among U.S. South Asian adult participants of a culturally adapted, group lifestyle intervention

ObjectivesThis qualitative study aimed to characterize how social networks influence cardiovascular health behaviors among U.S. South Asian adults in a culturally adapted, group lifestyle intervention. MethodsA purposive sample of participants (n = 24) from the South Asian Healthy Lifestyle Intervention (SAHELI) randomized trial’s intervention arm participated in semi-structured process evaluation interviews. Specific open-ended questions were used to probe participants’ behavior changes, personal social networks, and social support for behavior change. The team transcribed interviews and identified themes using inductive and deductive coding, based on a theoretical model of social influence. ResultsAmong 24 participants (67 % female, mean age 50.5 years, 88 % foreign-born, 50 % with limited English proficiency), three themes emerged: 1) SAHELI participants and their family members provided bidirectional social support for behavior change; 2) intervention participants provided social support to one another; and 3) participants faced resistance to change from some community members. ConclusionsBehavior changes initiated during SAHELI diffused to participants’ close family members. Several social network influences varied by participant gender, English language proficiency, and network member type. Practice ImplicationsHealth professionals should ask patients about how their social networks facilitate or hinder behavior changes. Gender and cultural factors may modify how social networks influence behavior change.

The Role of Addiction Treatment in Building Recovery Capital: Findings From 2022 Life in Recovery Survey in Flanders, Belgium

Introduction: This paper examines life experiences before and during addiction recovery in a large sample of treated and untreated persons in Flanders (Belgium). Methods: A total of 343 participants in recovery from alcohol and/or illicit drug problems (≥3 months) completed the 2022 ‘Life in Recovery’ survey online. Participants were categorized into four groups based on their engagement with treatment services: (1) unassisted recovery, (2) mutual aid support only, (3) formal treatment only, and (4) formal treatment and mutual aid support. The questionnaire was supplemented with open-ended questions about facilitators and barriers to recovery. Findings: Group comparisons revealed significant differences in the severity of dependence and living conditions (recovery strengths and barriers, SABRS) during addiction between those in recovery without treatment and the treatment groups. However, similarities in strengths, barriers, and quality of life during recovery were observed across all groups. Differences in barriers during recovery were attributed to variations in initial conditions rather than treatment engagement. The complementary qualitative analysis revealed that the four clusters experienced similar factors as facilitating and hindering recovery. Discussion: These findings suggest that while various pathways can lead to recovery, those involving formal treatment and mutual aid support may be particularly valuable for individuals facing greater initial barriers and fewer strengths during addiction, highlighting treatment as an important but not universally necessary source of recovery capital.

Engagement analysis of a persuasive-design-optimized eHealth intervention through machine learning

The challenge of sustaining user engagement in eHealth interventions is a pressing issue with significant implications for the effectiveness of these digital health tools. This study investigates user engagement in a cognitive-behavioral therapy-based eHealth intervention for procrastination, using a dataset from a randomized controlled trial of 233 university students. Various machine learning models, including Decision Tree, Gradient Boosting, Logistic Regression, Random Forest, and Support Vector Machines, were employed to predict patterns of user engagement. The study adopted a two-phase analytical approach. In the first phase, all features of the dataset were included, revealing ‘total_minutes’—the total time participants spent on the intervention and the eHealth platform—as the most significant predictor of engagement. This finding emphasizes the intuitive notion that early time spent on the platform and the intervention is a strong indicator of later user engagement. However, to gain a deeper understanding of engagement beyond this predominant metric, the second phase of the analysis excluded ‘total_minutes’. This approach allowed for the exploration of the roles and interdependencies of other engagement indicators, such as ‘number_intervention_answersheets’—the number of completed lessons, ‘logins_first_4_weeks’—login frequency, and ‘number_diary_answersheets’—the number of completed diaries. The results from this phase highlighted the multifaceted nature of engagement, showing that while ‘total_minutes’ is strongly correlated with engagement, indicating that more engaged participants tend to spend more time on the intervention, the comprehensive engagement profile also depends on additional aspects like lesson completions and frequency of platform interactions.

Randomised controlled pilot trial of the EndoSMS supportive text message intervention for individuals with endometriosis: Feasibility and acceptability results

ObjectiveDiminished quality of life, inadequate support and social isolation are commonly experienced by individuals living with the chronic pain condition, endometriosis. We aimed to determine the feasibility and acceptability of EndoSMS, a psychologically-focused text message intervention designed to support individuals living with endometriosis. MethodsAs part of a two-arm parallel pilot randomised controlled trial with waitlist control, the feasibility and acceptability of a brief (3-month) version of EndoSMS was assessed using a mixed methods approach. Feasibility data (uptake, attrition, text message delivery analytics) and user acceptability (via self-report survey items and written feedback) were assessed. Qualitative data were thematically analysed using the template approach. Primary trial outcomes are not reported in this paper. ResultsFeasibility was indicated by: high conversion rate (99.1 %), low attrition (14.2 %), few opt-outs (0.02 %) and a high message delivery rate (99.8 %). Most intervention participants indicated user acceptability (mean = 4.02/5) across self-report questions. Most rated the length of the program (65.5 %), and the number (80.9 %) and language (94.5 %) of the text messages to be ‘just right’. Thematic analysis created four themes: A shared “battle”: Feeling less isolated and alone; “Be kind to yourself”: A focus on self-care, self-compassion and active coping; Keeping endometriosis at the forefront: Helpful or stressful?; Mixed perceptions surrounding the provision of general endometriosis information; and, Tailoring of text messages. ConclusionEndoSMS supportive text message program was feasible and acceptable for individuals with endometriosis. Future developments of the program should consider greater tailoring of content to user needs.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12621001642875).

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors

South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults. This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion. A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly. Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models. Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control. In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation. ClinicalTrials.gov Identifier: NCT03336255.