Phone Delivery Research Articles

Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19

Objective: There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery. Method: PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT. Results: PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms. Conclusions: PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.

Characterizing provider-led adaptations to mobile phone delivery of the Adolescent Transition Package (ATP) in Kenya using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS): a mixed methods approach

BackgroundThe COVID-19 pandemic resulted in disruptions to routine HIV services for youth living with HIV (YLH), provoking rapid adaptation to mitigate interruptions in care. The Adolescent Transition to Adult Care for HIV-infected adolescents (ATTACH) study (NCT03574129) was a hybrid I cluster randomized trial testing the effectiveness of a healthcare worker (HCW)-delivered disclosure and transition intervention — the Adolescent Transition Package (ATP). During the pandemic, HCWs leveraged phone delivery of the ATP and were supported to make adaptations. We characterized real-time, provider-driven adaptations made to support phone delivery of the ATP.MethodsWe conducted continuous quality improvement (CQI) meetings with HCWs involved in phone delivery of the ATP at 10 intervention sites. CQI meetings used plan-do-study-act (PDSA) cycles and were audio-recorded. Adaptations were coded by two-independent coders using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Adaptation testing outcomes (adopt, retest, or abandon) and provider experience implementing the adaptations were also recorded. We summarized adaptation characteristics, provider experience, and outcomes.ResultsWe identified 72 adaptations, 32 were unique. Overall, adaptations included modification to context (53%, n = 38), content (49%, n = 35), and evaluation processes (13%, n = 9). Context adaptations primarily featured changes to personnel, format, and setting, while content and evaluation adaptations were frequently achieved by simple additions, repetition, and tailoring/refining of the phone delivery strategy. Nine adaptations involved abandoning, then returning to phone delivery. HCWs sought to increase reach, improve fidelity, and intervention fit within their context. Most adaptations (96%, n = 69) were perceived to increase the feasibility of phone delivery when compared to before the changes were introduced, and HCWs felt 83% (n = 60) of adaptations made phone delivery easier. Most adaptations were either incorporated into routine workflows (47%) or tested again (47%).ConclusionAdaptation of phone delivery was a feasible and effective way of addressing challenges with continuity of care for YLH during the COVID-19 pandemic. Adaptations were primarily context adaptions. While FRAME-IS was apt for characterizing adaptations, more use cases are needed to explore the range of its utility.Trial registrationTrial registered on ClinicalTrial.gov as NCT03574129.

Adaptation, acceptability and feasibility of Problem Management Plus (PM+) intervention to promote the mental health of young people living with HIV in Kenya: formative mixed-methods research.

Problem Management Plus (PM+) is a psychological intervention that seeks to address common mental disorders among individuals exposed to adversity. Thus far, the potential for delivering PM+ by mobile phones has not been evaluated. To adapt PM+ for telephone delivery (ten weekly sessions of about 45 min each) and preliminarily evaluate its acceptability and feasibility with young people living with HIV (YLWH) in coastal Kenya. This was a mixed-method formative research. Qualitative data collection included consultations with stakeholders, conducting key informant interviews with HIV care providers and focus group discussions with potential end-users, i.e. YLWH. Moreover, brief exit interviews with recipients of the adapted PM+ were conducted. Quantitative acceptability and feasibility indicators and outcome measures were tracked/assessed during PM+ preliminary implementation involving 70 YLWH. From the qualitative inquiries, the adapted PM+ emerged as contextually appropriate, acceptable and feasible for mobile phone delivery, despite some concerns around missing nonverbal cues and poor network connectivity. High recruitment (85%) and fair programme retention (69%) were observed. Intervention sessions over the telephone lasted 46 min on average (range 42-55 min). Preliminary feasibility data indicated that the adapted PM+ has the potential of reducing common mental disorders among YLWH from the Kenyan coast. PM+ is acceptable and can feasibly be delivered via mobile phone to YLWH in coastal Kenya. This study sets the stage for a future fully powered, randomised controlled trial assessing the efficacy of the adapted PM+ in this or a similar setting.

The effect of multiple ınterventions for women at risk for cervical cancer on their health responsibility, beliefs regarding cervical cancer and having screening: a randomized controlled trial.

This study was intended to analyze the effect of multiple initiations on beliefs about cervical cancer, health responsibility, and screening participation. In total, 134 women aged 40-55 years, who were at risk of cervical cancer and had never had a Pap smear before, were randomly assigned to the experimental (n = 67) and control (n = 67) groups. The 14 weeks of sessions involving the experimental group included group training on cervical cancer, counselling, reminder phone calls and delivery materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group received the usual care. The study data were collected using an information form, the Health Belief Model Scale, the Healthy Lifestyle Behaviors Scale II and the Assessment Form for Undergoing Pap-Smear Test. After the multiple interventions, there was a significant difference between the experimental and control group's Health Responsibility, Pap smear benefit and motivation, obstacle and health motivation scores (P < 0,05). The participation rate of women in the experimental group to cervical cancer screening was found to be 93%. Multiple nursing interventions (group training, counselling, reminder phone calls and delivery materials) were effective in increasing participation in cervical cancer screening programs.

청소년이 배달음식점을 통한 주류구매 시 나이 확인 여부와 언어네트워크를 활용한 청소년 음주조장환경에 관한 인식

Purpose: This study explored the physical availability of alcoholic beverages to adolescents through online liquor sales, based on a semantic network analysis. Method: Two methods were used: 1) first, an experimental study was conducted of 300 restaurants with app and phone delivery to verify whether the IDs of adolescents were checked when purchasing alcoholic beverages; then, 2) focus group interviews with two groups (adolescent drinkers and adolescent non-drinkers) were carried out to explore characteristics of the physical availability of alcoholic beverages to adolescents, drinking motives, alcohol advertising, and drinking behaviors. Differences in ID checks in the Seoul area, delivery application type, day of the week, and delivery food type were analyzed using a frequency analysis test. A semantic network analysis was used to investigate the relationship between keywords. The network characteristics were identified using a community analysis. Results: Only 14.7% of online sales checked whether an ID or guardian was present. Thirty-seven and 20 meaningful keywords were extracted from the texts of adolescent drinkers and non-drinkers, respectively, and the community analysis revealed four sub-communities: 1) peer inluences, alcohol advertisement, physical availability of alcohol, and liquor sales for adolescent drinkers and 2) physical availability of alcohol, Alcohol temptations, alcohol-related images, and online liquor sales for non-drinkers. Keywords gave the impression of a tolerant drinking culture. The adolescents’ alcohol use was associated with the ease of physically obtaining alcohol, their positive perceptions of alcohol, family factors, peer influences, and social and cultural aspects of alcohol consumption in general. Although alcohol should not be explicitly sold to adolescents, the results of this study confirmed that it was easy for adolescents to purchase alcoholic beverages. They also confirmed that the main channel for adolescents to experience drinking or to come into contact with alcoholic beverages was the family environment, i.e., their parents’ tolerant attitude toward alcohol. Conclusion: Therefore, for the prevention of drinking among adolescents, targeting only adolescents is not effective, and a campaign to raise awareness and change the overall drinking culture of society is needed.

To what extent do weather and climate information services drive the adoption of climate-smart agriculture practices in Ghana?

There is a growing interest in understanding the linkages between the use of weather and climate information services (WCIS) and the adoption of climate-smart agricultural (CSA) practices. At present, however, there is little guidance on the impact of the use of WCIS on the adoption of CSA practices. This study examines this nexus by focusing on mobile phone delivery channels of weather forecasts through the ESOKO platform in the Upper West Region of Ghana. We employ a simultaneous equation system with a recursive bivariate probit model in which both the outcome (CSA practices) and the endogenous treatment variable (WCIS) are binary. We found the use of WCIS is endogenously treated to farmers in the adoption models of pest-resistant crops, water management, and multiple cropping practices. The use of WCIS significantly increases the adoption of water management and multiple cropping practices by 6.8% and 5.6% respectively. We found, however, no statistical significance on the effects of WCIS on the adoption rates of erosion control, pest-resistant crops, and integrated pest management. Our findings underscore the importance of the source of information on agricultural practices (e.g. radio, TV), farmers’ characteristics (e.g. gender, age) and their perceptions of climate change in the decision to use WCIS. Pathways for promoting CSA practices should address the adoption barriers inherent to farmers’ characteristics and their livelihood strategies (e.g. livestock, income diversification).

Telephone-delivered behavioral health interventions for people living with HIV: patients’ perspectives from a qualitative study

ABSTRACT People living with HIV (PLWH) often experience mental health concerns as well as difficulties with medication adherence; they also report barriers to receipt of health services. Telephone-delivered interventions can overcome some of these barriers. To obtain patients’ perspectives on telephone-delivered behavioral health services, we conducted a qualitative study with patients who participated in one of two telephone-delivered interventions (mindfulness training, health coaching) in a research trial. Patients (N = 42; M age = 46 years, 50% female, 26% Black) participated in semi-structured qualitative interviews after completing the study. They identified several advantages (e.g., being able to schedule sessions more flexibly compared to in-person appointments, ease of developing rapport with interventionists) as well as occasional challenges of phone delivery (e.g., network connectivity). Overall, PLWH view telephone-delivery as a convenient and flexible method to engage in behavioral health interventions.

Experiences Receiving HIV-Positive Results by Phone: Acceptability and Implications for Clinical and Behavioral Research.

Improving HIV testing rates and increasing early detection among men who have sex with men (MSM) are critical strategies for enhancing overall health and decreasing HIV transmission. Remote testing and phone delivery of HIV test results may reduce barriers such as geographic isolation or HIV-related stigma. In 2018–19, 50 MSM completed qualitative interviews about their experience receiving a positive HIV test result via phone through their participation in a research study that included remote HIV testing. Interview topics included the acceptability of, and concerns about, phone delivery of HIV results, as well as suggestions for improvement. Interviews were transcribed, coded, and analysed using an inductive thematic approach. Overall, participants reported high acceptability of phone delivery of HIV-positive results. Participants praised the support and information provided by study staff. Benefits identified included increased convenience compared to in-person medical visits, allowing participants to emotionally process their test results privately, as well as receiving the results from supportive and responsive staff members. A few participants indicated drawbacks to phone-based HIV test result delivery, such as logistical concerns about receiving a phone call during the day (e.g., while at work), reduced confidentiality, and the lack of in-person emotional support. Overall, participants described phone delivery of positive HIV-results as acceptable. At-home testing with phone delivery has the potential to increase HIV testing access, especially to geographically isolated or medically underserved patients.

An RCT to Increase Breast and Colorectal Cancer Screening

Adherence to breast and colorectal cancer screenings reduce mortality from these cancers, yet screening rates remain suboptimal. This 2 × 2 RCT compared 3 theory-based interventions to usual care to simultaneously increase breast and colon cancer screening in women who were nonadherent to both screenings at study entry. RCT. Women (n=692) who were nonadherent to both breast and colon cancer screenings and aged 51-75 years were recruited. Enrollment, intervention delivery, and data collection were completed between 2013 and 2017, and data analyzed in 2018. The randomized intervention included the following 4 groups: 3 intervention arms (personally tailored messages using a web-based intervention, phone delivery by a trained navigator, or both) compared with usual care. Women at an average risk for colon cancer were allowed to select either colonoscopy or stool test as their preferred colon cancer screening. Mammography was promoted for breast cancer screening. Outcome data at 6 months included self-report and medical records for screening activity. All intervention arms significantly increased receipt of either a mammogram or stool test compared with control (web: p<0.0249, phone: p<0.0001, web + phone: p<0.0001). When considering receipt of both mammogram and stool test, all intervention arms were significantly different from usual care (web: p<0.0249, phone: p<0.0003, web + phone: p<0.0001). In addition, women who were adherent to mammography had a 4.5 times greater odds of becoming adherent to colonoscopy. The tailored intervention simultaneously supporting both breast and colon cancer screenings significantly improved rates of obtaining one of the screenings and increased receipt of both tests. This study is registered with the clinical trials identifier NCT03279198 at www.clinicaltrials.gov.

Collection of Common Knee Patient-reported Outcome Instruments by Automated Mobile Phone Text Messaging in Pediatric Sports Medicine

Patient-reported outcome (PRO) instruments measure health status in a variety of domains. With the proliferation of mobile phones, delivering PROs across patient-friendly platforms (eg, apps, text messaging) may increase completion rates, particularly among children. The purpose of this study was to validate the collection of common knee PROs in sports medicine with text messaging by correlating text-messaging responses with paper delivery in adolescents. Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled prospectively. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) were completed during initial clinic visits. Over the next 72 hours, patients completed the text message delivery of the Pedi-IKDC and Pedi-Fab Scale. Correlations between paper and text message delivery of the 2 PROs were assessed. Ninety-one patients (mean age: 16.0±2.0 y; 48% females) enrolled in the text-messaging study, with 55 (60.4%) completing the Pedi-Fab Scale, 48 (52.7%) completing the Pedi-IKDC, and 39 (42.9%) completing both PROs. The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-Fab Scale was 0.95 (P<0.001; 95% confidence interval, 0.91-0.97). The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (P<0.001; 95% confidence interval, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (P=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (P=0.41). Average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 and 159±155 minutes, respectively. High school enrollment (P=0.025), female sex (P=0.036), and race (P=0.002) were significantly associated with text completion of Pedi-IKDC. Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fab scores in adolescents. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance and reduce the labor cost of collecting PROs. Level III-prospective cohort study.

2028. A Survey of Antimicrobial Availability, Training, and Antimicrobial Recommendations by Staff in Pharmacies and Non-pharmacy Stores in the Dominican Republic

BackgroundAntimicrobial resistance (AMR) is a rising global health challenge. Antimicrobial use (AU) is a key factor in the development of AMR, but knowledge gaps remain on AU and dispensation in low- and middle-income countries (LMICs). AU can be purchased without prescriptions in many LMICs and are available in pharmacies and non-pharmacy stores. We seek to describe the availability, training and AU recommendations in pharmacies and non-pharmacy stores in the Dominican Republic (DR).MethodsWe conducted a survey of pharmacies and non-pharmacy stores that dispense antimicrobials from March to April 2019 in randomly selected locations throughout metropolitan Santo Domingo. Data on the availability of antimicrobials and training on AU was obtained. Antimicrobial of choice for common symptoms such as dysuria, throat pain, diarrhea, fever, and cough were queried, and data tabulated. Availability of antimicrobials by phone and online delivery was assessed.ResultsA total of 35 stores were surveyed. Ten pharmacies and 15 nonpharmacy stores agreed to participate. Ten refused and were excluded. Fifty AU recommendations were given in pharmacies and 16 in non-pharmacy stores. The most common type of antimicrobial recommended were aminopenicillins (Figure 1). Staff received prior training on antimicrobials in 70% of pharmacies and 0% of non-pharmacy stores. Antimicrobial recommendations by symptom in pharmacies and non-pharmacy stores are seen in Figure 2 and 3. Antimicrobials are available for phone delivery in 100% of pharmacies and 90% of non-pharmacy stores. No antimicrobials were available via online delivery apps.ConclusionAntimicrobials are widely available in the DR without prescriptions and can be purchased in person or via phone delivery. Aminopenicillins are commonly prescribed and may contribute to high rates of ESBL in the DR. Pharmacy staff gave more specific symptom-based recommendations than non-pharmacy staff and commonly had prior training on antibiotic use. In LMICs with easy access to antimicrobials, frontline staff in pharmacies and non-pharmacy stores are gatekeepers for AU and may benefit from further education and training. Further studies on attitudes and perceptions related to antimicrobial use in the community are needed. Disclosures All authors: No reported disclosures.

DELIVERY OF COMMON KNEE PATIENT-REPORTED OUTCOME INSTRUMENTS BY AUTOMATED MOBILE PHONE TEXT MESSAGING IN PEDIATRIC SPORTS MEDICINE

Background: Patient-reported outcome (PRO) instruments measure a patient’s health status in a variety of domains, including physical, mental and social well-being. The delivery of such instruments has become an integral part of healthcare, commonly employed to assess treatment efficacy and outcomes in sports medicine. With the proliferation of mobile phones, administration of PROs across patient-friendly platforms (e.g. apps, text messaging) may increase completion rates, particularly among younger patients. The purpose of this study was to validate the collection of common knee PROs with text messaging in sports medicine, by correlating text messaging responses with traditional paper delivery in adolescents and young adults. Methods: Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled in this prospective investigation. Patients were excluded if they were undergoing a same-day office procedure, underwent surgery within the previous 90 days, and/or had no access to a mobile phone. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) questionnaires were completed during the patients’ initial clinic visit. Over the next 72 hours, the patients subsequently completed the mobile phone portion of the study outside of the clinic (Figure 1), which included text message delivery of the Pedi-IKDC and Pedi-Fab Scale, assigned in a random order. Correlations between paper and text message delivery of the two PROs were assessed. Secondary analyses were conducted to examine overall completion time and associations between patient demographics and text compliance. Results: Of the 91 patients (Age M=16.0 ±2.0 years; 48% female) initially enrolled in the study, 55 (60.4%) completed the text Pedi-Fab Scale, 48 (52.7%) completed the text Pedi-IKDC, and 39 (42.9%) completed both PROs. Among the evaluable sample, the intraclass correlation coefficient (ICC) between the paper and mobile phone delivery of the Pedi-Fabs was 0.95 (95% CI, 0.91-0.97). The ICC between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (95% CI, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (p=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (p=0.41). A Bland-Altman plot and linear regression revealed there was no proportional bias between the mean and difference for the Pedi-Fab scores (p=0.55) and Pedi-IKDC scores (p=0.56). The average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 minutes and 159±155 minutes, respectively. For Pedi-Fab, there were no patient demographics that were significantly associated with text completion. However, high school students (p=0.025), female sex (p=0.036), and race (p=0.002), were significantly associated with the text completion of Pedi-IKDC. In addition, order of the delivery of the questionnaires and paper scores were not associated with text completion for either survey. Conclusion: Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fabs scores in this prospective observational study. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance among high school students while also reducing the labor cost of collecting PROs.

From Innovation to Transcreation: Adapting Digital Technologies to Address Violence against Children

With seven billion mobile phone subscriptions and a third of the world's population going online, digital information and communication technologies present untapped platforms for communication, learning and empowerment. Newer technologies such as mobile phones, the internet and computers have the potential to contribute significantly to the prevention of violence against children. Yet, efforts to date have focused primarily on the risks associated with them. It is important to consider how digital technologies can enhance social and behaviour change interventions to prevent and respond to violence against children. We conducted a systematic review of social and behaviour change interventions addressing violence against children. We searched five databases for peer‐reviewed and grey literature published between 2000 and 2015, which yielded 18 manuscripts relevant to the use of computers, the internet or mobile phones. Digital technologies were typically combined with other communication channels in order to reach children, parents, teachers or service providers. We are unable to draw any conclusions on the direct effectiveness of digital technologies, indicating the need for more rigorous evaluations to assess their added value. Future work should explore how digital technologies can be integrated into programmes disseminating information, raising awareness, helping individuals report violence and mobilising communities to action. Copyright © 2017 John Wiley &amp; Sons, Ltd.Key Practitioner Messages Successful violence prevention programmes are not taking full advantage of digital technologies. Adapting programmes and messages for computer, internet or mobile phone delivery would broaden their scope and reach. The interactive nature of digital technologies makes them ideally suited to involve and empower individuals and entire communities for change. The effectiveness of digital technologies in preventing violence against children is still unclear. More investment in research and evaluation is needed. ‘A systematic review of social and behaviour change interventions addressing violence against children’‘The effectiveness of digital technologies in preventing violence against children is still unclear’

Delivery of Patient-Reported Outcome Instruments by Automated Mobile Phone Text Messaging.

Patient-reported outcome (PRO) instruments allow patients to interpret their health and are integral in evaluating orthopedic treatments and outcomes. The purpose of this study was to define: (1) correlation between PROs collected by automated delivery of text messages on mobile phones compared with paper delivery; and (2) patient use characteristics of a technology platform utilizing automated delivery of text messages on mobile phones. Paper versions of the 12-Item Short Form Health Survey (SF-12) and the short form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) were completed by patients in orthopedic hand and upper extremity clinics. Over the next 48 hours, the same patients also completed the mobile phone portion of the study outside of the clinic which included text message delivery of the SF-12 and QuickDASH, assigned in a random order. Correlations between paper and text message delivery of the 2 PROs were assessed. Among 72 patients, the intraclass correlation coefficient (ICC) between the written and mobile phone delivery of QuickDASH was 0.91 (95% confidence interval [CI], 0.85-0.95). The ICC between the paper and mobile phone delivery of the SF-12 physical health composite score was 0.88 (95% CI, 0.79-0.93) and 0.86 (95% CI, 0.75-0.92) for the SF-12 mental health composite score. We find that text message delivery using mobile phones permits valid assessment of SF-12 and QuickDASH scores. The findings suggest that software-driven automated delivery of text communication to patients via mobile phones may be a valid method to obtain other PRO scores in orthopedic patients.

Mobile App-Delivered Cognitive Behavioral Therapy for Insomnia: Feasibility and Initial Efficacy Among Veterans With Cannabis Use Disorders.

BackgroundCannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention.ObjectiveThis pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone–delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt.MethodsFour male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually.ResultsBoth participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation.ConclusionsThis pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention.

Addressing medication nonadherence by mobile phone: Development and delivery of tailored messages

Medication nonadherence remains a significant public health problem, and efforts to improve adherence have shown only limited impact. The tailoring of messages has become a popular method of developing communication to influence specific health-related behaviors but the development and impact of tailored text messages on medication use is poorly understood. The aim of this paper is to describe an approach to developing theory-based tailored messages for delivery via mobile phone to improve medication adherence among patients with diabetes. Kreuter's five-step tailoring process was followed to create tailored messages for mobile phone delivery. Two focus group sessions, using input from 11 people, and expert review of message content were used to adapt the survey instrument on which the messages were tailored and edit the developed messages for the target population. Following established tailoring methods a library of 168 theory-driven and 128 medication-specific tailored messages were developed and formatted for automated delivery to mobile phones. Concepts from the Health Belief Model and Self-Determination Theory were used to craft the messages and an algorithm was applied to determine the order and timing of messages with the aim of progressively influencing disease and treatment-related beliefs driving adherence to diabetes medication. The process described may be applied to future investigations aiming to improve medication adherence in patients with diabetes and the effectiveness of the current messages will be tested in a planned analysis.

Abstract 86: Methodological Issues in Telephone Interventions for Stroke Survivors and Family Caregivers

Background: Post-stroke follow-up interventions are increasingly delivered by telephone. Though many studies report comparable outcomes for phone and in-person delivery, little is reported regarding the feasibility of using this technology in stroke. Purpose: We report positive and negative aspects of phone interventions in two ongoing stroke studies, including strategies to overcome limitations Methods: Study A is comparing a tailored phone intervention with an active listening phone intervention for 254 stroke family caregivers. Study B is comparing tailored in-person versus phone interventions in 100 stroke survivors. Researchers in both studies identified facilitators and barriers to using the telephone. Results: Advantages of phone delivery included ease of access for both caregivers and survivors, less time commitment, and no pressure to present a good appearance (of the home or self). Study A sessions averaged 30 minutes for the tailored intervention versus 16 minutes for active listening. Caregiver rapport was easily established with both interventions. Nurses expressed relief that the study was conducted by phone given the number of rescheduled appointments. Study B phone sessions were shorter than in-person (25 minutes vs. 35-40). There were particular challenges for survivors who had expressive language difficulty, and motor deficits made it hard for some to hold the phone. Hearing deficits posed difficulty, as well as background noise and the lack of ability to “see” nonverbal cues. Investigators used speaker phones when possible for persons with limitations and also recorded conversations to further interpret responses. Conclusions: Though telephone delivery poses some challenges, these can be overcome. For stroke caregivers, advantages clearly outweigh the disadvantages, though for stroke survivors, speakerphones and/or videoconferencing may improve quality. Further research using telephone technologies needs to be conducted, particularly in today’s cost-sensitive health care environment where in-person delivery methods are increasingly under scrutiny.

Equivalent weight loss for weight management programs delivered by phone and clinic.

Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone). Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups. Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person. Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach.

Texting for Health: The Use of Participatory Methods to Develop Healthy Lifestyle Messages for Teens

To develop and test messages and a mobile phone delivery protocol designed to influence the nutrition and physical activity knowledge, attitudes, and behavior of adolescents. Nine focus groups, 4 classroom discussions, and an 8-week pilot study exploring message content, format, origin, and message delivery were conducted over 12 months using a multistage, youth-participatory approach. Youth programs at 11 locations in Arizona. Recruitment was coordinated through youth educators and leaders. Eligible teens were 12-18 years old and enrolled in youth programs between fall 2009 and 2010. Adolescent preferences for messages and delivery of messages. Qualitative data analysis procedures to generate themes from field notes. One hundred seventy-seven adolescents participated in focus groups (n = 59), discussions (n = 86), and a pilot study (n = 32). Youth preferred messages with an active voice that referenced teens and recommended specific, achievable behaviors; messages should come from nutrition professionals delivered as a text message, at a frequency of ≤ 2 messages/day. More than 300 messages and a delivery protocol were successfully developed and tested in partnership with adolescents. Future research should address scalability of texting interventions; explore dose associated with changes in knowledge, attitudes, and behaviors; and offer customized message subscription options.

MEMO—A Mobile Phone Depression Prevention Intervention for Adolescents: Development Process and Postprogram Findings on Acceptability From a Randomized Controlled Trial

BackgroundPrevention of the onset of depression in adolescence may prevent social dysfunction, teenage pregnancy, substance abuse, suicide, and mental health conditions in adulthood. New technologies allow delivery of prevention programs scalable to large and disparate populations.ObjectiveTo develop and test the novel mobile phone delivery of a depression prevention intervention for adolescents. We describe the development of the intervention and the results of participants’ self-reported satisfaction with the intervention.MethodsThe intervention was developed from 15 key messages derived from cognitive behavioral therapy (CBT). The program was fully automated and delivered in 2 mobile phone messages/day for 9 weeks, with a mixture of text, video, and cartoon messages and a mobile website. Delivery modalities were guided by social cognitive theory and marketing principles. The intervention was compared with an attention control program of the same number and types of messages on different topics. A double-blind randomized controlled trial was undertaken in high schools in Auckland, New Zealand, from June 2009 to April 2011.ResultsA total of 1348 students (13–17 years of age) volunteered to participate at group sessions in schools, and 855 were eventually randomly assigned to groups. Of these, 835 (97.7%) self-completed follow-up questionnaires at postprogram interviews on satisfaction, perceived usefulness, and adherence to the intervention. Over three-quarters of participants viewed at least half of the messages and 90.7% (379/418) in the intervention group reported they would refer the program to a friend. Intervention group participants said the intervention helped them to be more positive (279/418, 66.7%) and to get rid of negative thoughts (210/418, 50.2%)—significantly higher than proportions in the control group.ConclusionsKey messages from CBT can be delivered by mobile phone, and young people report that these are helpful. Change in clinician-rated depression symptom scores from baseline to 12 months, yet to be completed, will provide evidence on the effectiveness of the intervention. If proven effective, this form of delivery may be useful in many countries lacking widespread mental health services but with extensive mobile phone coverage.ClinicalTrialAustralia New Zealand Clinical Trials Registry (ACTRN): 12609000405213; http://www.anzctr.org.au/trial_view.aspx?ID=83667 (Archived by WebCite at http://www.webcitation.org/64aueRqOb)